One word decides a GI claim: screening or diagnostic.
The same colonoscopy is free to the patient as a screening and carries a deductible as a diagnostic. Coding it wrong creates either an angry patient or an unpaid claim.
- 97%Coding accuracy on audit
- 50+Specialties covered
- 4.9/5Average client rating
Three ways Gastroenterology claims quietly lose value
Review these issues against the documentation, remittance and policy that applied on the date of service. They can appear as denials or underpayments.
- Screening converted to diagnostic without the modifier
When a polyp is found during a screening, the coding changes and a modifier preserves the patient benefit. Without it the patient is billed for a screening they were told was covered.
- Surveillance intervals not tracked
Repeat scopes are covered on defined intervals that vary by finding and by payer. Early is unpaid.
- Anesthesia billed without coordination
The facility, the anesthesia and the professional claim have to agree. When they do not, one of the three is denied.
What we bill for Gastroenterology practices
If something you do is not on this list, ask. We will tell you honestly whether we have the depth for it.
How Gastroenterology accounts are actually run
The worklist connects each claim to its documentation, payer requirements and next follow-up date.
- A gastroenterology coder, not a general one
The coder assigned to your account works gastroenterology every day. They already know which of your payers do what, and they are watching screening versus diagnostic rules, modifier use and anesthesia coordination.
- Charges checked against the note
Before anything goes out, the charge is read against the documentation. A code the note does not support is a recoupment waiting to happen, and in gastroenterology it is usually the highest value code on the claim.
- Eligibility and authorization ahead of the visit
Coverage is confirmed and any approval is in place before the service, not discovered afterwards when the work has already been done.
- Denials worked to cause, not just refiled
Every denial is tagged by payer and reason code. When a pattern shows up in your gastroenterology claims we change the upstream step so it stops recurring.
- Reporting you can act on
Monthly numbers by procedure family and payer, with the one decision they imply, rather than an export nobody opens.
Included for Gastroenterology practices
- Coders who work gastroenterology daily
- Charge review against documentation
- Eligibility and benefit verification
- Prior authorization management
- Denial management by payer and reason code
- Aged A/R worked oldest first
- Patient statements and balance follow up
- Monthly reporting by procedure family
These describe how we run the service. They are commitments about our process, not a guaranteed outcome on any individual claim.
We work inside the system you already use
We agree user permissions, claim queues, reporting access and escalation contacts in your current system before work begins.
Gastroenterology billing across the country
These state guides explain local Medicaid programs and payer administration. They cover general billing requirements, rather than a separate Gastroenterology service in each state.
Arizona payer guideAHCCCS and 7+ plans
Washington payer guideApple Health and 7+ plans
Texas payer guideTexas Medicaid and 8+ plans
New York payer guideNY Medicaid and 8+ plans
California payer guideMedi-Cal and 8+ plans
Ohio payer guideOhio Medicaid and 8+ plans
Florida payer guideFlorida Medicaid and 8+ plansWhat Gastroenterology practices ask
How do you protect the patient screening benefit?
With the correct modifier when a screening becomes diagnostic, which is exactly what it exists for.
Do you track surveillance intervals?
Yes, per patient and per finding, because the interval depends on both.
Can you coordinate with the surgery centre?
Yes. The three claims have to tell the same story.
Do you handle biologic infusions?
Yes, including authorization, units and wastage.
Have a gastroenterology coder read your last ninety days
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.