Gastroenterology Billing Services
Gastroenterology billing services are specialty billing and revenue cycle services built specifically for GI practices where a single missing modifier on a colonoscopy with polyp removal, or the wrong coding when a screening turns diagnostic mid-procedure, is the difference between a full multi-component payment and a bundled, underpaid claim.
EverCure Billing handles the complete revenue cycle for gastroenterology providers across the United States: eligibility checks, prior authorizations, endoscopy coding, claim submission, denial appeals, and aged A/R recovery. Your team runs the scopes and treats the patients. We make sure the work you already did actually gets paid every billable component of it.
What Are Gastroenterology Billing Services?
Gastroenterology billing services cover every financial step between a patient booking a procedure and that money landing in your practice account.
For a GI practice specifically, that includes verifying benefits before an endoscopy, obtaining prior authorization for advanced procedures, coding each procedure with the correct CPT, ICD-10, and modifier combination including the screening-versus-diagnostic distinction that decides both reimbursement and patient cost-share capturing every billable component of a multi-step endoscopy, submitting a clean claim, posting the payment, appealing the denial when the payer pushes back, and chasing the balance until it clears.
General medical billing stops at "submit the claim." Gastroenterology billing fails or succeeds at the modifier level, because a GI procedure is almost never one code it's a base procedure plus components, sedation, and often a screening rule that changes everything.
Why Do Gastroenterology Practices Lose More Revenue Than They Should?
Because GI is a multi-component, high-volume, screening-heavy specialty and every one of those traits is a place a claim can leak. These are the specific leaks we see when we run audits on GI practices:
Bundling on multi-component endoscopy
A colonoscopy with polyp removal, biopsy, and control of bleeding is several billable services. Without the correct distinct-service modifier applied the way that payer expects, the payer bundles them into one underpaid claim and the rest is lost.
Screening-to-diagnostic conversion errors
A screening colonoscopy that finds and removes a polyp becomes a diagnostic and therapeutic procedure mid-exam. Coding that conversion wrong missing the screening-conversion or preventive modifiers costs reimbursement and can wrongly bill the patient for a service that should have been covered.
Incomplete and aborted procedures coded wrong
A colonoscopy that can't be completed still represents real work, but it has to be billed with the correct discontinued or reduced-service modifier. Bill it as a full procedure and it denies; bill it as nothing and the work is written off.
Moderate sedation billed incorrectly or not at all
Moderate sedation is separately reportable in many GI encounters. Practices routinely miss it or code it wrong, leaving billable work on the table on nearly every procedure.
Capsule endoscopy and EUS component and necessity gaps
Capsule endoscopy splits into a professional and technical component and carries strict coverage criteria. Endoscopic ultrasound with fine-needle aspiration has its own add-on rules. Miss the component split or the medical-necessity documentation and the claim denies.
Prior authorization and medical necessity failures
ERCP, capsule endoscopy, and EUS carry different authorization thresholds across payers, and each has coverage policy behind it. No auth, or documentation that doesn't meet the policy, means denial.
We build the workflow around these six failure points, because they are where GI practice revenue actually disappears.
What Gastroenterology Billing Services Does
EverCure Billing Provide?
Insurance eligibility and benefits verification
We verify active coverage, plan type, deductible status, coinsurance, and procedure-specific benefits before the patient arrives including whether a colonoscopy falls under screening or diagnostic benefits, so nobody is surprised by a bill that should have been covered.
Prior authorization support
We prepare and submit authorization requests for ERCP, capsule endoscopy, EUS, and other advanced procedures, track each payer's threshold, attach the required clinical documentation, follow up until a decision is issued, and track expiry dates so approvals don't lapse before the procedure date.
Gastroenterology medical coding
Our coders work from your procedure notes and pathology to assign the correct CPT, ICD-10-CM, and HCPCS codes with the right component capture, screening-versus-diagnostic handling, sedation coding, and modifier set. Every code is tied back to what the documentation actually supports.
Charge entry and claim scrubbing
Every claim runs through a pre-submission check for payer-specific edits, NCCI bundling conflicts on multi-component endoscopy, modifier logic, diagnosis-to-procedure linkage, and screening-conversion rules before it leaves our office.
Claim submission and clearinghouse management
Electronic submission, rejection handling at the clearinghouse level, and same-day correction and resubmission on front-end rejects.
Payment posting and reconciliation
ERA and manual EOB posting, contractual adjustment verification, and underpayment identification because payers do pay below contracted rates, and most practices never catch it.
Denial management and appeals
Every denial is categorized by root cause, corrected, and appealed with the supporting documentation the payer is actually asking for. We also feed denial patterns back into coding so the same denial stops repeating.
Accounts receivable follow-up and recovery
Structured follow-up on aged claims by bucket (30 / 60 / 90 / 120+ days), with priority given to high-dollar procedure claims and anything approaching a timely filing deadline.
Patient billing and support
Clear patient statements, balance explanations including the screening-versus-diagnostic cost-share questions GI practices field constantly and a support line so your front desk isn't buried in them.
Provider credentialing and payer enrollment
New provider enrollment, re-credentialing, CAQH maintenance, and Medicare enrollment through PECOS so a new gastroenterologist in your group isn't sitting idle waiting on a payer panel.
Billing audits and compliance review
Periodic internal review of coding accuracy, modifier usage, documentation strength, and screening-conversion handling to reduce audit exposure before a payer finds it first.
Financial reporting
Monthly reporting on collections, clean claim rate, denial rate by reason, days in A/R, and payer performance in plain language, not a data dump.
Which Gastroenterology Procedures
Do You Bill?
Colonoscopy screening, diagnostic, and interventional, with correct coding for polyp removal, biopsy, control of bleeding, and the screening-to-diagnostic conversion when it happens.
Flexible sigmoidoscopy all encounter types with precise CPT selection and the discontinued-procedure modifier when an exam can't be completed.
Upper GI endoscopy (EGD) with every billable component captured, including biopsy, dilation, and therapeutic interventions.
ERCP primary and add-on biliary and pancreatic codes sequenced correctly, with authorization verified and documentation complete.
Endoscopic ultrasound (EUS) diagnostic and interventional, including fine-needle aspiration add-ons, documented to meet medical-necessity requirements.
Capsule endoscopy professional and technical component billing with the physician interpretation and clinical evidence coverage policy requires.
Moderate sedation coded separately where reportable, so it isn't left off the claim.
Motility and anorectal studies manometry and related diagnostics coded to specificity.
Hepatology and GI office care evaluation and management visits, medication management, and same-day E/M with a procedure handled through correct modifier 25 support.
Non-covered and investigational services ABN workflow and patient responsibility handling so your practice isn't absorbing the cost of services the payer was never going to cover.
Which Gastroenterology CPT and ICD-10 Codes
Do You Work With?
| Code Range | What It Covers |
|---|---|
| 99202–99215 | New and established patient E/M visits |
| 45378–45398 | Colonoscopy diagnostic, biopsy, polyp removal, control of bleeding |
| 45330–45350 | Flexible sigmoidoscopy |
| 43235–43259 | Upper GI endoscopy (EGD) biopsy, dilation, therapeutic |
| 43260–43278 | ERCP biliary and pancreatic procedures and add-ons |
| 43237, 43238, 43242 | Endoscopic ultrasound with fine-needle aspiration |
| 91110, 91111 | Capsule endoscopy small bowel imaging |
| 91117–91122 | Anorectal and motility studies |
| 99151–99153 | Moderate sedation |
| G0105, G0121, Z12.11 | Screening colonoscopy and screening encounter |
| K21 | Gastroesophageal reflux disease (GERD) |
| K50, K51, K52 | Crohn's disease, ulcerative colitis, and other colitis |
| K57 | Diverticular disease by site and complication |
| K58 | Irritable bowel syndrome |
| K70–K77 | Liver disease, including cirrhosis and hepatitis |
| K80 | Cholelithiasis (gallstones) |
| K92 | Gastrointestinal bleeding |
Code sets update annually and payer rules update more often than that. Keeping current on both including annual GI code and fee schedule changes is part of the service, not an extra.
Which Modifiers Actually Decide Whether
a GI Claim Gets Paid?
Distinct procedural service, used to correctly separate the billable components of a multi-step endoscopy so each is reimbursed.
Colorectal cancer screening test converted to a diagnostic or therapeutic procedure. Gets the reimbursement and the patient's cost-share right when a screening finds something.
Preventive service, identifying a screening so covered preventive benefits apply.
Discontinued procedure, for a colonoscopy or sigmoidoscopy that can't be completed.
Reduced services, when less than the full procedure is performed.
Professional versus technical component, particularly on capsule endoscopy.
Significant, separately identifiable E/M on the same day as a procedure, documented properly.
Repeat procedure by the same or a different physician.
Advance beneficiary notice and non-covered service indicators.
Confirmation that coverage requirements in the payer's policy have been met.
How Does Compliance Work in Gastroenterology Billing?
Screening, diagnostic, and preventive rules
Screening colonoscopy carries specific coverage and cost-share protections, and a screening that converts to diagnostic has to be coded so the patient isn't wrongly billed and the practice isn't underpaid. We handle that conversion by the current rules, not by guesswork.
Medical necessity and coverage policy
Medicare LCDs and commercial medical policies define what has to be documented before capsule endoscopy, EUS, and other advanced procedures are covered. We review documentation against the applicable policy before the claim goes out, not after it denies.
NCCI bundling on multi-component endoscopy
GI is one of the specialties most exposed to bundling edits. We apply procedure-specific modifier logic so each legitimately separate component is reimbursed.
Audit readiness
High endoscopy volume draws payer and program audit attention. We keep documentation trails complete and coding defensible so a review finds a clean record.
HIPAA and data security
Every EverCure Billing team member works under signed HIPAA agreements with role-based access to PHI, secure data transfer, and no PHI on personal devices or unsecured channels.
How Does
Onboarding Work?
Free billing audit
We review a sample of recent claims, denials, and your aged A/R to identify where revenue is being lost and how much of it is recoverable.
Findings and scope
You get a written summary of what we found and a clear proposal services, pricing, and timeline. No obligation to continue.
System access and setup
We work inside your existing EHR and practice management system. No migration, no software purchase, no disruption to your clinical team.
Workflow mapping
We document your procedure mix, top payers, current denial patterns, and internal handoffs, then build the billing workflow around how your practice actually runs.
Go live
Claims start flowing through our process. In parallel, we begin working your existing aged A/R old money is usually the fastest win.
Ongoing reporting and review
Monthly financial reporting, a dedicated account manager, and a scheduled review call to go through what's working and what needs to change.
Typical onboarding runs about two to four weeks depending on system access and practice size.
Which EHR and Practice Management Systems
Do You Work In?
We work directly in your current system rather than asking you to change platforms. Our team has worked across eClinicalWorks, AdvancedMD, NextGen, athenahealth, Kareo/Tebra, DrChrono, Practice Fusion, CareCloud, Epic, and Cerner, along with GI-specific and endoscopy-center platforms.
If your system isn't listed, tell us which one you use in most cases we can be trained and productive in it within days.
Who Do We Work With?
We serve practices nationwide, with a growing footprint in Indiana and New Jersey.
What Does Gastroenterology Billing Cost?
Our gastroenterology billing services are priced as a percentage of monthly collections so our revenue only grows when yours does. Your exact rate depends on procedure mix, monthly claim volume, payer mix, and which parts of the cycle you want us to handle.
There are no setup fees and no long-term lock-in contracts. If you want a specific number, the free audit is the fastest way to get one that's accurate rather than generic.
Why Choose EverCure Billing for Gastroenterology Billing?
We work the complex claims, not just the easy ones.
Multi-component endoscopy, screening conversions, and ERCP add-on sequencing take real documentation review and modifier logic. That's the work we don't write it off and move on.
You get a named account manager, not a ticket queue.
One person who knows your practice, your payers, and your procedure mix, reachable directly.
Direct access to leadership.
We're built to stay close to our clients. When something goes wrong, you're not escalating through four layers to get an answer.
Denial data goes back into coding.
Every denial reason is tracked and fed back upstream so the same error stops repeating. Most billing companies just resubmit.
Transparent reporting.
You see clean claim rate, denial rate by reason, days in A/R, and collections every month, explained clearly.
No long-term contracts.
We keep your business by performing, not by locking you in.
Is Your GI Practice Leaving Money on the Table?
Most GI practices don't know their real denial rate, how much of their aged A/R is still collectible, or how much they're losing to bundled multi-component claims until someone actually looks.
That's what the free audit is for. We review your recent claims, denials, and A/R and give you a written breakdown of what's recoverable and what's causing the leak. No cost, no obligation.
Frequently Asked Questions
About Gastroenterology Billing
Yes. Our team works with the detail GI billing requires multi-component colonoscopy coding, screening-to-diagnostic conversion, ERCP add-on sequencing, capsule endoscopy component splitting, and moderate sedation. General billing knowledge alone doesn't cover any of that.
We apply the correct screening-conversion and preventive modifiers so the procedure is reimbursed fully and the patient isn't wrongly billed for a service that should have been covered.
Yes. We log into your current system and work inside it. There is no software to buy and no migration required.
Both. Aged A/R is usually where the fastest recovery is available, so we start working it in parallel with new claim submission.
Yes. We track each payer's threshold, prepare and submit the request, attach the clinical documentation, follow up until a decision is issued, and track approval expiry dates.
Yes. New provider enrollment, re-credentialing, CAQH maintenance, and Medicare enrollment are all available, either bundled with billing or as a standalone service.
All work is performed under signed HIPAA agreements with role-based PHI access, secure transfer methods, and no PHI stored on personal devices.
A monthly report covering collections, clean claim rate, denial rate by reason, days in A/R, and payer-level performance plus a review call to walk through it.
Start with the free billing audit. You'll get a written picture of where your revenue is leaking before you commit to anything.
Ready to Fix Your Gastroenterology Revenue Cycle?
Every bundled claim and every aged account is money your practice already earned. Let's go get it.
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