Gastroenterology Billing and Coding Services – In Depth  Guid

Touseef Riaz

June 6, 2022

outsourced billing for gastroenterology

Gastroenterology is a health care specialty that deals with the digestive tract and its issues. This specialty concentrates on the problems of the gastrointestinal tract, in which the organs from the mouth to the stomach and the organs throughout the alimentary canal are included. Gastroenterologists are specialists in this field of medicine.

gastroenterology billing

Why do you need gastroenterology billing services?

When considering the various billing methods, remember that medical invoicing is sophisticated and necessitates much knowledge and experience. The medical billing firm must have a knowledgeable team with the complicated criteria that insurance companies use to evaluate health claims for gastroenterology. When a specialty, such as gastroenterology, is involved, the conditions for gastrointestinal billing effectiveness become even more challenging to meet.

Healthcare centres and gastroenterology practices cannot afford to leave income uncollected by billing agencies or freelancers unfamiliar with gastroenterology invoicing and endoscopy billing as the expense of offering gastroenterology-related medical facilities continues to climb. It’s also worth noting that while some billing organizations advertise themselves as huge gastroenterology billing service providers, they outsource gastroenterology billing to individuals who operate from home. Hiring such organizations will result in revenue loss because of the lack of suitable processes, controls, and training. 

Appealing refused claims and answering exceedingly specific and technical questions regarding procedures and diagnosis are crucial battlegrounds in the battle to accumulate all of the money due to a gastroenterologist. Success In this field, you need much experience, the type that only comes from working with many gastroenterologists for a long time.

The capacity to track underpayments is required for good gastrointestinal and endoscopy billing. This requirement frequently exceeds the capability of many billing organizations’ billing software. This is a severe flaw because pursuing underpayments properly can boost a gastroenterologist’s earnings by 7 to 10%.

Patient collections are affected by these billing issues as well. Owing to the more significant patient balances generally outstanding and the intricacy of the procedures/EOBs that should be discussed with patients who do not comprehend their bills, the patient data gathering for experts like gastroenterology is more involved. These problems are best handled by a medical billing agency that specializes in gastrointestinal billing. Without such experience, billing businesses run the danger of decreased patient collections and upset patients who are unsure about their charges.

Bottom line: Using a billing business that does not specialize in gastroenterology and endoscopy billing is not worth taking the risk for a gastroenterologist. Your revenue cycle must be managed by a reputable and knowledgeable Gastroenterology billing firm. Gastroenterology encompasses giving the best possible patient service and therapy and a variety of additional factors. Due to the complexity of Gastroenterology medical codes, medical billing for this specialty can be more complicated than other things. As a result, competent Gastroenterology coders familiar with cardiovascular terms, coding, and invoicing are required. You must also be familiar with current encoding, updates, billing, and other procedures. Gastrointestinal billing services are time-consuming; therefore, working with billing experts specializing in gastroenterology billing will help you succeed financially. Medical billing solutions to medical organizations provide outsourced billing for gastroenterology and tailored solutions. As we’re in control of the gastrointestinal billing, these organizations are committed to offering only high-quality medical care. The related codes and processes of billing insurance firms for a patient’s gastrointestinal procedure are referred to as gastroenterology medical billing. Precise medical coding assures that insurance carriers have all the diagnostic codes needed to make proper payments. Accurate coding is also necessary for demographic research, illness prevalence studies, treatment outcomes studies, and transparent and accountable reimbursement systems.

Essentially, medical billing for gastroenterology is critical to your business’s success and the community you assist.

CPT Codes for Gastroenterology:

There are approximately 72,000 ICD-10-CM codes to pick from, and finding the exact number in a computerized medical record and the invoicing system can be tricky. Personnel education and development are critical for making your practice’s billing department as effective as possible while dealing with medical codes.

To begin, here are some frequent gastrointestinal CPT codes:


  • Allergic and dietary gastroenteritis and colitis, K52.2
  • Other noninfectious gastroenteritis and colitis (K52.89)
  • Diarrhea, nonspecific R19.7

Ot/Multi-Site Abdominal Pain:

  • R10.10 Unspecified upper abdominal pain
  • Pelvic and perineal discomfort (R10.2)
  • R10.30 Unspecified lower abdominal pain

Neo Rectum/Anus Benignum:

  • D12.7 Rectosigmoid junction benign neoplasm
  • D12.8 Rectal benign neoplasm
  • D12.9 Anus and anal canal benign neoplasm

Eructation/Gas Flatulence:

  • Abdominal distension (R14.0) (gaseous)
  • R14.1 Constipation
  • Eructation R14.2
  • Flatulence, R14.3

Neo Lg Bowel Benign:

  • D12.0 Cecum benign neoplasm
  • D12.1 Appendix benign neoplasm
  • D12.6 Colon benign neoplasm, unspecified

Gastroenterology Practices’ Top Medical Billing Tips

Here are a few of the most acceptable practices for gastrointestinal medical billing for the greatest possible experience.

1. Medical billing requires collaboration:

To ensure that everything is reported correctly following payer standards, doctors and coding staff must maintain open lines of communication. The physician is in charge of providing correct and specific paperwork and returning orders to the billing department for claim submission. Any significant changes in billing should be communicated to doctors or providers as soon as possible.

2. Bill for Evaluation and Management (E&M) Services Appropriately:

The first actions conducted for people at any gastroenterological clinic are Evaluation and management. To assist any initial meeting with patients, three requirements must be met: the history taken, the examination conducted, and the formation of a treatment plan. When billing, there are five levels of care for office appointments and three levels for inpatient appointments, so it’s critical to choose the correct level.

3. Diagnostic Studies Language:

Medical urgency for testing must be verified to submit costs for diagnostic studies. Anomalous lab tests, indications, and symptoms usually merit additional inquiry, which are the most critical indicators for testing. Make sure the test results’ interpretation is clear and a strategy or advice for further measures.

The following are the primary billing and coding considerations for gastroenterologists:

Ensure that proper documentation is in place:

For successful billing, proper documentation is required for accurate code assignment and medical necessity. Lack of medical condition can result in refused claims and authorization rejection for laboratory testing, medication, diagnostic investigations, and other procedures. Many procedures and tests have localized coverage determinations (LCDs) from Medicare and commercial payers, including indications and restrictions and approved diagnosis codes. GI Hepatology News keeps reminding us that paperwork for endoscopy and procedural billing should also include the methodology used to cure the area inside the digestive tract, the position of lesions or abnormalities, the technique of treatment/removal, and the reason(s)/indication(s) for those procedures, in addition to medical necessity. All of these facts must be recorded in the endoscopic report to bill each surgery. Different colon tools can be recorded separately with an effective modifier to indicate that they were utilized to treat various lesions/abnormalities.

Medical necessity/indication for testing must be documented when invoicing diagnostic studies and procedures. The most important red flags for screening are abnormal blood tests, signs, and symptoms. The analysis of the test results and any recommendations should be included in the documentation (GI Hepatology News).

E/M Guidelines to Know and Follow:

In 2021, there will be notable improvements to gastro-specific E/M services. To optimize medical billing and maximize reimbursement, clinicians must understand how to record appropriately and code Evaluation and administration of patient visits. Time and clinical decision-making are the two factors used to give E/M codes. CPT altered the meaning of time linked with 99202-99215 from “average face-to-face time” to “time consumed on the day of the contact” beginning in 2021. The goal of this update was to make time more clear when many providers are involved. 

The following activities are included in the total time:

  • Getting ready to see the patient
  • Obtaining information individually
  • Examining information obtained independently
  • Taking the examination
  • Patient/family counseling and education
  • Obtaining prescriptions, tests, or procedures
  • Other health care experts are referred to and communicated with.
  • Recording the treatment
  • Interpreting and conveying test results to the patient/family independently.
  • Coordination of care

It’s worth noting that, while the background, exam, and MDM are all essential aspects of the encounter, they have no bearing on code selection when time is the deciding issue. 

Correct Use of Modifiers:

The discrepancy between modifier 51 (many operations) and modifier 59 (single procedure) is one of the most common gastrointestinal coding errors (distinct procedural service). These modifiers are utilized when several services are performed, although they serve different objectives. Modifier 51 denotes that the same practitioner performed numerous operations (other than E/M) during the same session. When the operations are listed in order of RVU, modifier 51 is often used to characterize the second and following operative processes to third-party payers, but it is not added to the principal procedure depending on what has been done to alleviate the patient’s ailment. Modifier 59 Distinct Operational Service denotes that a process is distinct and separate from another operation performed on the same day. Modifier 59 can be used for many sessions or encounters on the same day of service; a different operation from the previous procedure; another anatomic site; and a separate incision, excision, damage, or body part.

Select the Correct ICD-10 Codes:

ICD-10 codes support the medical need for the services given. Healthcare coders must allocate diagnostic codes to the highest level of specificity documented, just as clinicians must record the most precise clinical diagnosis. This is necessary for appropriate claim submission and reimbursement. When a physician cannot diagnose the condition for interaction, the disease or diseases must be coded as accurately as possible, including indications, signs, abnormal test findings, or another cause for the visit. Comorbidities can be coded to aid decision-making at a higher level.

Mistakes in GI invoicing and coding

The first step in preventing revenue loss caused by billing and coding errors is to educate yourself. Recognize the most common blunders and how to avoid them in your gastroenterology practice.

  • Mistake #1: Documentation Defects Gaps in the documentation are the most common blunders contributing to under-coding and maybe even claim rejections. Clear documentation is essential as data openness grows and more payers demand verification of medical necessity. Failure to record critical data during the clinical documenting and coding process might result in claims being rejected because there isn’t enough paperwork to back them up. As requests are outright refused without sufficient paperwork, delayed revenues become lost revenues.
  • Mistake #2: Incorrect Modifier Use– The incorrect use of modifiers is another typical GI coding error. Modifiers 51 and 59 are frequently mixed up, resulting in rejected claims. Modifier 51 must be employed for two methods performed on the same day in two separate code groups. When a new site is visited, or a different treatment is performed on the same day that would typically be one, you must use modifier 59.
  • Mistake #3: Failing to Stay Current on CPT Updates– The CPT code set varies slightly every year, and most of these variations affect gastroenterology practices. Codes can be removed, applications can change, and new regulations can be introduced. Staying up to date on developments is critical for avoiding costly denials.

Important GI Invoicing and Coding Hints

To avoid costly denials, keep the following GI invoicing and coding suggestions in mind:

  • The majority of endoscopic treatments entail bleeding control. Remember that bleeding control isn’t usually billed separately. It cannot be paid differently unless the patient has a GI bleed that is the primary cause of the endoscopy. 
  • It’s important to distinguish between the diagnostic and screening colonoscopies. These ICD-10 codes can be used to report screening colonoscopies:.
  • 11 – colon testing for malignant neoplasm.
  • 010 – colonic polyps personal history.
  • 0 – history of malignant neoplasms of the digestive organs in the family.

Healthcare Rules for Testing Protocols: When polyps are discovered and removed during screening colonoscopies, Medicare needs a separate modifier. With the modifier PT, the right CPT must be applied.

Top Challenges & Solutions for Gastroenterology Billing

Gastroenterologists must keep up with payer-specific guidelines and coding restrictions to sustain a complaint and economically successful practice. Healthcare invoicing and coding for a gastroenterologist is challenging and demands a wide range of skills to achieve optimal compensation. Invoicing for gastric cancer screenings, colonoscopies, agility, and investigations into GI function, with acceptable documentation assessment and administration procedures, type III codes for GERD medication, and using qualifiers -59, -26, and -51 are just a few examples of the issues.

Additionally, excellent underpayment tracking is required for GI  and endoscopy billing. Often these invoicing software and in-house accounting professionals cannot meet this need. GI practices that do not adequately target underpayments risk losing much money. On-time billing, prompt follow-up, and financial reimbursement are all closely tied to the cash generated by your gastroenterology services. Contracting a reputable medical billing services firm is one of the most critical decisions healthcare practitioners must make regarding the business side of things.

A medical practice’s financial backbone comprises healthcare billers and medical invoicing services. Medical procedures like gastroenterology billing that do not have the proper medical billing expertise on their side might quickly lose more than 20% of their potential earnings.

When it comes to using medical invoicing services to halt the bleeding of income from their offices, doctors have many alternatives. Home-based medical billers are on the lower end of the scale. On the other hand, gastroenterology billing  companies hire hundreds of healthcare billers and serve tens of thousands of clients.

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