Specialties
Medical billing for gastroenterology
A colonoscopy can start as a screening and end as a procedure in the same visit. How that’s billed changes both what you’re paid and what the patient owes.
What makes GI billing hard
- Screening that becomes diagnostic. When a polyp is removed during a screening colonoscopy, the claim needs a specific modifier, which differs between Medicare and commercial payers, to keep the screening benefit and set the patient’s cost share correctly.
- Follow-up after a positive stool test. Medicare and many plans treat the follow-up colonoscopy as part of screening, and the claim has to show that.
- Multiple endoscopies. Several procedures in one session are paid under special reduction rules, so the expected payment has to account for them.
- Anesthesia is often billed by a separate provider, who also needs the screening status to bill correctly.
- Setting. Office, ambulatory surgery center and hospital procedures are billed and paid differently.
How we work it
We confirm the reason for each colonoscopy before the procedure, apply the right modifier for each payer when the procedure changes, and share the screening status with the anesthesia biller. Payments are checked against the multiple-procedure rules so underpayments are caught.
Common questions
Why did a patient get a bill after a screening colonoscopy?
Usually because a polyp was removed and the claim didn’t carry the modifier showing the procedure began as a screening. Applying it correctly protects the patient’s screening benefit.
Do you bill for anesthesia on endoscopy cases?
We can, and if another group bills anesthesia we make sure they receive the screening status so their claim matches yours.
Start with the free audit
Send us ninety days of claims data and we’ll show you what was left uncollected. No charge, no obligation, and the findings are yours either way.
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