Skip to content Credex Healthcare provides gastroenterology billing services for gastroenterologists, hepatologists, endoscopy centers, and multi-provider GI groups dealing with colonoscopy bundling disputes, prior authorization denials for upper endoscopy, and the compliance risk associated with billing a screening colonoscopy that becomes a therapeutic procedure.
Credex Healthcare’s gastroenterology revenue cycle management handles that level of detail in every case.
First-pass claim approval rate
Average GI billing turnaround
Medicare, Medicaid & commercial networks
Colonoscopy conversion & prior auth tracking
Credex Healthcare runs a dedicated gastroenterology billing process that reviews each procedure report before charge entry. For endoscopy cases, our GI billing specialists confirm that the procedure code matches what the endoscopist documented, that add-on codes for biopsy and polypectomy are applied correctly alongside the base endoscopy code, that screening-to-therapeutic conversion is handled with the right modifier, and that prior authorization status matches the procedure actually performed. Gastroenterology billing errors and fixes are expensive when they are caught on the remittance. A polypectomy billed without the right add-on code, or a screening colonoscopy that should have been billed as therapeutic, costs money on every case where it happens.
Our gastroenterology billing services in the USA cover the following:
Procedure claims proceed with submission with verified CPT codes, correct add-on code relationships, screening-to-therapeutic modifiers applied where applicable, and prior authorization on file for scheduled procedures. Our team tracks every claim through adjudication and follows up before the timely filing windows close.
We manage provider enrollment for gastroenterologists, hepatologists, and APPs with Medicare, Medicaid, and commercial carriers, including ASC and endoscopy center facility enrollment, where your group owns or operates a procedure suite.
Within 48 hours, denied claims are looked at again. If the claim was turned down because of a colonoscopy bundle disagreement, a missing biopsy add-on code, a prior permission mismatch, or an error in screening-to-therapeutic conversion, our team fixes it and resubmits with the treatment paperwork to support it.
Our certified coders check procedure reports against gastroenterology CPT codes 43235, 43239, 45378, 45385, and the full GI endoscopy code set. They ensure that the relationships between base and add-on codes are correct, that modifiers are used according to payer rules, and that the procedure report supports every submitted code.
Most business payers must approve upper and lower endoscopy treatments before they can be performed, even if they are used only for screening. Before treatments are planned, we start and keep track of authorizations so that no endoscopy case goes forward without the funder’s permission for the type of operation and reason for it.
Eligibility verification, endoscopy, and office-based charge capture review, payment sending, facility and professional claim settlement, and monthly reports are all part of end-to-end RCM. This way, GI practice managers can get accurate collection data by treatment type and provider each cycle.
As a dedicated gastroenterology billing company in the USA, Credex Healthcare tracks Medicare’s colonoscopy screening benefit rules, monitors commercial payer policy changes on endoscopy prior authorization requirements, and maintains current documentation standards for the full GI endoscopy code set, including capsule endoscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound. Medicare coverage for GI procedures operates differently between screening and diagnostic indications, and cost-sharing rules change when a screening colonoscopy is converted to therapeutic. A billing team that handles those conversions incorrectly costs the practice revenue and creates incorrect patient billing at the same time.
Medicare covers a screening colonoscopy every 10 years for average-risk beneficiaries with no cost-sharing, but cost-sharing applies when a polyp is removed. Diagnostic colonoscopy carries different frequency rules. We manage Medicare GI billing with correct code selection, adherence to cost-sharing rules, and the use of therapeutic conversion modifiers in every case.
Medicaid gastroenterology coverage and prior authorization requirements vary significantly by state. Some programs require PA on both screening and diagnostic endoscopy. Our team maintains state-specific Medicaid GI billing rules and prior-authorization workflows for every state in which your practice operates.
GI practices operating an ambulatory surgery center or endoscopy center bill facility and professional claims separately, each with different CPT codes, revenue codes, and fee schedules. We manage both billing tracks as a coordinated workflow, so facility and professional claims are reconciled and submitted correctly for every case.
Hepatology billing for liver disease management, hepatitis treatment, and liver biopsy carries its own CPT code set, prior authorization requirements, and documentation standards. Our GI billing specialists handle hepatology alongside standard endoscopy billing as part of the same integrated practice workflow.
GI claims fail for specific, traceable reasons: colonoscopy codes billed without the correct add-on for polypectomy, screening procedures billed at the diagnostic rate, prior authorizations that do not match the procedure performed, and procedure reports that do not document findings sufficiently to support a therapeutic code. Credex Healthcare reviews all of that before any claim is filed.
Every gastroenterologist, hepatologist, and APP in your practice is verified for active enrollment with each payer, correct specialty taxonomy, and current credentialing status before claims go out under their provider number. Facility enrollment for any endoscopy center is verified separately.
We audit procedure reports against the full GI CPT code set, including 43235 (upper GI endoscopy, diagnostic), 43239 (EGD with biopsy), 45378 (diagnostic colonoscopy), and 45385 (colonoscopy with polypectomy), confirming that add-on codes are applied alongside the correct base code and that no standalone add-on code is submitted without its required primary procedure.
Screening-to-Therapeutic Conversion
When a screening colonoscopy leads to polyp removal, the claim must shift from the screening code to the therapeutic code with the PT modifier to preserve the patient's cost-sharing benefit while billing at the correct therapeutic rate. We apply that conversion on every applicable case, not just when it is flagged by the coder.
Prior Authorization Tracking
Prior authorization for endoscopy procedures is tracked per patient and per payer. Authorization covers the specific procedure code and indication. When a diagnostic colonoscopy is converted to a therapeutic mid-case, we verify whether the existing authorization covers the therapeutic procedure or whether a supplemental request is needed.
Gastroenterology Documentation Requirements
Procedure reports must document findings, the extent of the examination, quality measures, such as bowel prep adequacy and cecal intubation, and any interventions performed, including the technique used. We review procedure reports for the documentation elements each payer requires before charge entry.
Accounts Receivable Follow-Up
GI AR is reviewed weekly. Unpaid claims are pursued before the filing deadlines close. Colonoscopy bundling disputes and polypectomy add-on code downgrades are escalated with the procedure report and payer policy documentation that supports the original billing.
GI practices lose revenue due to billing patterns that are not apparent until an expert reviews the data. Colonoscopies where the polypectomy is performed, but 45385 was not billed because the coder defaulted to the diagnostic code. Screening colonoscopies converted to therapeutic without the PT modifier applied, costing the patient incorrect cost-sharing and the practice a compliance risk. ERCP cases where the fluoroscopy add-on was not applied. Credex Healthcare’s gastroenterology billing process builds a procedure-level review into every case before the claim is filed, so those patterns do not persist for months before someone notices them.
End-to-end gastroenterology insurance billing from procedure report review and charge entry through CPT and add-on code assignment and electronic submission to Medicare, Medicaid, and commercial payers for every endoscopy and office encounter.
Our gastroenterology billing specialists apply the correct endoscopy billing codes and modifiers for every procedure type, base code, and add-on code combination, and screening-to-therapeutic conversions, reducing denials from GI documentation requirements errors.
Prior Authorization Management
Prior authorization for endoscopy procedures is tracked from initiation through approval and confirmed as current at the time of service. Therapeutic conversions during a case trigger an automatic authorization coverage check before billing.
Denial management for gastroenterology claims covers disputes over colonoscopy bundling, add-on code denials, therapeutic conversion billing corrections, and prior authorization mismatch appeals. Each appeal is built around the procedure to report language and payer policy that reverses the denial.
Provider application management covers gastroenterologist enrollment, APP incident-to billing setup, endoscopy center facility enrollment, and ongoing recredentialing so your practice and facility bill without interruption as payer agreements renew.
Monthly reports cover collections by procedure type and payer, endoscopy billing denial trends by CPT code, colonoscopy conversion rate tracking, gastroenterology billing turnaround time, and AR aging, so practice administrators have the data to manage the business.
Years of GI Billing Expertise
Provider & Facility Enrollment Success
Claim Compliance Rate Across All Payers
Support Available for All Your Needs
Customized GI Revenue Cycle Solutions
MD
Adaeze
“We were doing about 80 colonoscopies a month, and the polypectomy conversion billing was inconsistent. Some cases where polyps were removed were being coded as 45378 instead of 45385, and the PT modifier for screening conversions was applied about 60% of the time. Credex reviewed three months of claims and identified every instance. They corrected the open claims, fixed the charge capture workflow, and our monthly endoscopy collections went up by a figure that was genuinely embarrassing to realize we had been leaving behind.”
Practice Administrator
Achebe
“Managing prior authorizations for diagnostic upper and lower endoscopy across nine physicians and two procedure suite locations was creating constant conflicts. Cases were being performed on expired authorizations without anyone catching it until the remittance came back denied. Credex built a per-patient, per-payer authorization tracking system and linked it to the scheduling workflow. Post-service auth denials dropped to near zero within two months.”
MD
Yulia
“Hepatology billing involves liver biopsy, FibroScan, and chronic liver disease management codes that most GI billing companies do not handle correctly. The coder we had was treating FibroScan as a generic ultrasound code, and we were leaving money on the table on every scan. Credex assigned a specialist who knew the hepatology-specific code set. Correct billing started in the first month, and the difference in liver procedure collections was measurable.”
MD
Marcus
“Running a physician-owned endoscopy center means billing both the facility and professional claims for every case. The facility and professional claims were going out with mismatched procedure dates and codes because two different billing systems were not communicating properly. Credex reconciled both billing tracks into one managed workflow, and the coordination errors stopped. The combined facility and professional collection rate improved, and the patient billing complaints dropped significantly.”
Revenue Cycle Manager
Sandra
“Our ERCP billing was consistently underpaid because the fluoroscopy add-on code was not being applied. Nobody had flagged it as a problem because the base ERCP code was paying. Credex audited the ERCP claims going back six months, identified the pattern, and recovered a meaningful amount through corrected claims. They also fixed the charge entry template so it could not happen again. That kind of audit is what we needed and did not know what to ask for.”
Practice Assessment
We audit your current GI billing workflow, endoscopy charge capture process, AR aging by procedure type and payer, denial history by CPT code and reason, colonoscopy conversion tracking, and prior authorization gaps. This shows exactly where collections are falling short, and which GI billing errors need to be addressed first.
Credentialing & Payer Enrollment
Every GI physician and APP is verified for active enrollment with each payer, correct specialty taxonomy, and credentialing status. Endoscopy center facility enrollment is verified separately for any procedure suite your group operates.
Prior Authorization Setup
We identify every procedure type and indication that requires prior authorization by the payer, build a patient-level tracking system linked to the scheduling workflow, and confirm that the authorization status covers the specific procedure code before the patient is placed on the procedure schedule.
Clean Claim Submission
Our gastroenterology billing specialists review each procedure report, verify base code and add-on code selection, apply screening-to-therapeutic conversion modifiers where applicable, and submit claims electronically to Medicare, Medicaid, and commercial payers for every case in the billing queue.
Denial Management & Follow-Up
Every claim is tracked through adjudication. Denials are reviewed within 48 hours. Colonoscopy bundling disputes, add-on code rejections, and prior authorization date conflicts each receive a targeted appeal built around documentation of a specific procedure and payer policy that will reverse the denial.
Reporting & Ongoing Optimization
Monthly reports cover collections by procedure type and payer, endoscopy denial trends by CPT code, colonoscopy conversion rate tracking, gastroenterology billing turnaround time, and AR aging. Recurring billing errors are corrected at the charge-entry level, not just addressed on a case-by-case basis.
Gastroenterology billing requires more than selecting a colonoscopy code and submitting the claim. Screening-to-therapeutic conversions, add-on code relationships for biopsy and polypectomy, ERCP fluoroscopy add-ons, endoscopic ultrasound documentation requirements, and payer-specific prior authorization rules for diagnostic endoscopy must all be accurate in every case. A general billing company handles the standard cases and misses the nuances. Credex Healthcare focuses on gastroenterology medical billing because this specialty requires billing specialists who handle GI claims daily and know where the revenue leaks sit.
Our team works on gastroenterology claims. We know how colonoscopy billing codes and modifiers work for screening, diagnostic, and therapeutic cases, how add-on codes for biopsy and polypectomy apply to each base endoscopy code, and where gastroenterology billing errors most commonly recur in procedure documentation and charge capture workflows.
Your practice works with one dedicated gastroenterology billing specialist who knows your procedure mix, payer contracts, endoscopy center setup, and the recurring denial patterns in your claims. Billing issues are handled by someone who already understands the full context.
Practice owners see collections by procedure type and payer, endoscopy denial trends by CPT code, colonoscopy screening-to-therapeutic conversion rate, AR aging, and gastroenterology billing turnaround time in monthly reports that reflect the actual financial position of the practice and the endoscopy facility.
Procedure reports, pathology results, and GI records handled throughout the billing process are protected under full HIPAA compliance protocols. Documented security standards and strict access controls are maintained across every system used to process your practice facility and professional claims.
Gastroenterology practices lose revenue through billing patterns that persist for months before anyone identifies them. Polypectomy cases are submitted as diagnostic colonoscopies. Screening-to-therapeutic conversions are missing from the PT modifier. ERCP fluoroscopy add-ons were not applied because the charge capture template was not processed. An audit finds these patterns in the first few weeks and quantifies their cost.
Credex Healthcare will first give you a free review of your current GI billing. This review will include: the amount of money you owe for procedures and payers; the history of denials by CPT code and reason; the accuracy of your charge captures for base and add-on codes; and any gaps in tracking prior authorizations. You do not have to make a promise to get that rating. We figure out how much can be recouped and the changes to the process that keep the same losses from happening in the next quarter.
Gastroenterology billing is the process of being paid for GI expert services such as endoscopies, office-based management and review visits, hepatology, and advanced GI services. Each treatment has a CPT code based on the endoscope method used and any changes performed. This code is tied to an ICD-10 diagnosis code that demonstrates the procedure is medically necessary and must be filed with the correct modifiers and prior permission paperwork.
There are CPT codes for upper endoscopy, colonoscopy, and other advanced gastroenterological treatments. Upper GI endoscopy without biopsy is coded as CPT 43235. The upper endoscopy with biopsy is CPT 43239. Diagnostic colonoscopy is CPT 45378. The procedure described in CPT 45385 is a colonoscopy with polyp removal by catch. Colonoscopy with biopsy is covered by CPT 45380. For diagnostic ERCP, the bill number is 43260, and for sphincterotomy, it is 43262. For endoscopic ultrasound, 43237 is used for EGD with EUS, and 45341 is used for colonoscopy with EUS.
When all the paperwork for the operation is in order and the right numbers are used, Medicare processes clean electronic GI claims in 14 to 30 days. Commercial payers usually pay within 30 days as long as there is prior authorization and a process report for every CPT code filed. Timelines for Medicaid vary by state but are usually between 30 and 60 days. All three are reviewed by Credex Healthcare’s pre-submission review before claims are submitted. This makes sure that most GI claims are processed within the standard timeframe for gastroenterology billing.
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