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Gastroenterology Billing Services That Treat Your Revenue Like a Patient
From colonoscopies and endoscopies to modifier use, prior authorizations, and payer edits, even small mistakes can slow payments and lead to denials. Medivantek diagnoses billing issues early, fixes revenue leaks, and keeps your claims moving smoothly. We help gastroenterology practices improve collections, reduce rejections, and build a healthier revenue cycle without adding stress to your team.
Overview
Gastroenterology Revenue Leaks and How We Fix
The Medicare Therapy Cap & KX Modifier
A screening colonoscopy (G0121) converts to a diagnostic or therapeutic code (45378-45385) the moment a polyp is identified or a biopsy is performed. Most billers know this rule. They still miss it. Because the documentation is buried in a procedure note that the biller never sees.
One Session, Three Procedures
Medicare applies a 50 percent payment reduction to the second and subsequent procedures performed in the same session. Most practices sequence codes randomly. The result is a lower payment than they deserve. We sequence your codes by RVU value — highest first — so the reduction applies to the lowest-value procedure, not the highest.
The POS Code That Changes Everything
The same colonoscopy code pays differently in a hospital outpatient department (POS 22), an ambulatory surgery center (POS 24), and an office-based suite (POS 11). One wrong place of service code triggers the wrong fee schedule. We verify the correct POS for every claim before submission.
Add-On Codes That Never Get Billed
Remove polyps from multiple segments of the colon? Add 45387. Control bleeding after polypectomy? Add 45382. These add-on codes increase reimbursement by 30 to 50 percent. They also require precise documentation and correct modifier application. We review every procedure note for billable add-ons. Nothing gets left behind.
| Procedure | Common Codes | What We Catch |
|---|---|---|
| Screening Colonoscopy | G0121 | Upgrade To 45385 When A Polyp Is Found |
| Diagnostic Colonoscopy | 45378 | Add Biopsy Code 45380 When Performed |
| Colonoscopy With Polypectomy | 45385 | Add 45387 For Multiple Segment Removal |
| Upper Endoscopy (EGD) | 43235 | Upgrade To 43239 When Biopsy Taken |
| EGD With Biopsy | 43239 | Do Not Bill A Separate Biopsy Code |
| ERCP | 43260-43278 | Code Varies By Intervention – We Match Exactly |
| Capsule Endoscopy | 91110 | Prior Authorization Required – We Handle It |
| Hemorrhoid Banding | 46221 | Covered For Symptomatic Internal Hemorrhoids |
| Biologic Infusion | 96413 + J-Code | Document Start/Stop Times Precisely |
| Moderate Sedation | 99152-99153 | Bill Only When GI Provider Gives Sedation |
Get It Right the First Time or Don’t Do the Case
We submit prior authorization requests within 24 hours of scheduling. We track authorization numbers, approved codes, effective dates, and expiration dates. We check each authorization before the claim goes out. No surprises. No denials. Commercial payers require prior authorization for:
- Non-screening colonoscopy (diagnostic or surveillance)
- ERCP
- Capsule endoscopy
- Biologic infusions (Remicade, Stelara, Entyvio)
Gastroenterology Billing Services That Treat Your Revenue Like a Patient
Pathology Billing – A Revenue Stream Most GI Practices Mismanage
Colonoscopy with biopsy generates two revenue streams: the procedure (billed by the GI practice) and the pathology (billed by the lab or pathologist).
Many GI practices outsource all pathology and leave significant revenue on the table. We help you evaluate whether in-house pathology makes financial sense. If you keep it in-house, we bill every 88305 unit correctly – one per biopsy site, not per specimen container.
| Procedure (Billed By The GI Practice) | Pathology (Billed By The Lab Or Pathologist) |
|---|---|
| When You Own The Lab And Employ The Pathologist | Use The Global Code (88305) With No Modifier. Keep 100 Percent. |
| When You Own The Lab, But An Outside Pathologist Reads The Slides | Lab Bills TC. Pathologist Bills 26. You Keep The Technical Component. |
| When A Reference Lab Processes The Specimens | The Lab Bills Everything. You Collect Nothing. |
How Medivantek Runs Your GI Revenue Cycle
Eligibility and Benefits Verification
We verify coverage before every procedure. Screening frequency. Diagnostic benefits. Prior authorization requirements. Visit limits. Patient cost-sharing. No surprises on the day of service.
Prior Authorization Management
We submit authorization requests within 24 hours of scheduling. We track approvals, effective dates, and expiration dates. We re-verify before every claim.
Charge Capture
We capture every charge from the procedure note. Colonoscopy. EGD. Biopsy. Polyp removal. Pathology. Infusion. No missed codes. No lost revenue.
Claim Scrubbing
We scrub every claim against GI-specific NCCI edits, payer policies, and Medicare LCDs. Wrong modifiers. Missing add-ons. Incorrect POS codes. We catch them before the claim goes out.
Denial Management
We work on every denial within 48 hours. We appeal with payer-specific arguments. We track denial patterns by payer and by code. We fix root causes, not just individual claims.
AR Management
We follow up on every unpaid claim at 15, 30, 45, and 60 days. We reconcile payments against contracted rates. We appeal underpayments. We keep your AR days low.
Gastroenterology Practices We Work With
Solo and Group GI Physician Practices
From solo practitioners to multi-physician groups. We scale to your volume and complexity.
Multi-Location GI Groups
We standardize billing across multiple office locations, ASCs, and hospital affiliations. One workflow. One reporting dashboard. One revenue stream.
Gastroenterology ASCs
We manage facility fee billing, professional component separation, and payer contract rates for GI-focused ASCs.
Academic and Hospital-Employed GI Departments
We integrate with academic EMRs. We manage teaching physician rules and split/shared visit billing.
Inflammatory Bowel Disease and Hepatology Subspecialty Practices
We handle biologic infusions, liver biopsies, and chronic case management for complex GI patients.
GI Compliance Where Practices Get into Real Trouble
Colonoscopy upcoding
Billing 45385 without documented polyp removal
Missing modifier 25
Billing an E/M on the same day as a procedure without documentation
Incorrect moderate sedation billing
Billing 99152 when a CRNA provided sedation
Unbundling
Billing separate codes for services that NCCI edits bundle
Ready To Simplify Your Gastroenterology Billing?
Frequently Asked Questions (FAQs)
What types of medical practices do you provide coding for?
We support over 25 specialties, including cardiology, neurology, orthopedics, behavioral health, internal medicine, and telehealth. Our coders have deep, specialty-specific expertise.
Are your medical coders certified?
Yes — all our coders are AAPC- or AHIMA-certified professionals trained in ICD-10, CPT, and HCPCS Level II. We stay current with all payer updates and regulatory changes.
How do you ensure accurate and compliant coding?
We use real-time code scrubbing tools, quarterly audits, and CDI feedback loops. Our team cross-checks modifiers, documentation, and payer rules to reduce denials and improve reimbursements.
Can you work within our existing EHR or billing software?
Absolutely. We integrate seamlessly with major platforms like eClinicalWorks, Athenahealth, NextGen, Kareo, AdvancedMD, and more—no workflow disruption required.
What's the benefit of outsourcing medical coding to Medivantek?
Outsourcing to us reduces overhead, improves claim accuracy, minimizes audit risk, and increases revenue by 20–30% through proper code utilization and documentation improvement.
