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First-pass claim approval rate
Average urology billing turnaround
Medicare, Medicaid & commercial networks
Colonoscopy conversion & prior auth tracking
Credex Healthcare runs a dedicated urology billing process that reviews each procedure report before charge entry. For endoscopy cases, our urology 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. Urology 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 urology billing services in USA cover the following:
Procedure claims go out 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 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 a screening-to-therapeutic conversion mistake, our team fixes it and sends it again with the treatment paperwork to back it up.
Our certified coders check procedure reports against urology CPT codes 43235, 43239, 45378, 45385, and the full urology endoscopy code set. They make sure that the relationships between base codes and add-on codes are correct, that modifiers are used according to payer rules, and that the procedure report backs up every code that was sent.
Most business payers need to approve upper and lower endoscopy treatments before they can happen, even if they are only used for screening purposes. Before treatments are planned, we start and keep track of authorizations so that no endoscopy case goes forward without funder 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, urology practice managers can get accurate collections data by treatment type and provider each cycle.
As a dedicated urology billing company in 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 urology endoscopy code set including capsule endoscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound. Medicare coverage for urology procedures operates differently for screening versus diagnostic indications, and the cost-sharing rules change when a screening colonoscopy converts to therapeutic. A billing team that handles those conversions wrong costs the practice money and creates incorrect patient billing at the same time.
Medicare covers 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 urology billing with correct code selection, cost-sharing rules, and therapeutic conversion modifiers for every case.
Medicaid urology 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 urology billing rules and prior authorization workflows for every state where your practice operates.
urology 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 urology billing specialists handle hepatology alongside standard endoscopy billing as part of the same integrated practice workflow.
urology 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 the findings specifically enough 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 urology CPT code set including 43235 (upper urology 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.
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 for endoscopy procedures is tracked per patient and per payer. Authorization covers the specific procedure code and indication. When a diagnostic colonoscopy converts to therapeutic mid-case, we verify whether the existing authorization covers the therapeutic procedure or whether a supplemental request is needed.
Procedure reports must document findings, extent of examination, quality measures like bowel prep adequacy and cecal intubation, and any interventions performed with the technique used. We review procedure reports for the documentation elements each payer requires before charge entry.
Accounts Receivable Follow-Up
urology AR is reviewed weekly. Unpaid claims are pursued before timely filing limits 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.
urology practices lose revenue through billing patterns that are not obvious until someone looks at the data. Colonoscopies where the polypectomy was 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 urology 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 urology 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 urology billing specialists apply the correct endoscopy billing codes and modifiers for every procedure type, base code and add-on code combinations, and screening-to-therapeutic conversions, cutting the denials from urology documentation requirement errors.
Prior Authorization Management
Prior authorization for endoscopy procedures is tracked from initiation through approval and confirmed current at the time of service. Therapeutic conversions during a case trigger an automatic authorization coverage check before billing.
Denial management for urology claims covers colonoscopy bundling disputes, add-on code denials, therapeutic conversion billing corrections, and prior authorization mismatch appeals. Each appeal is built around the procedure 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, urology billing turnaround time, and AR aging so practice administrators have the data to manage the business.
Years of urology Billing Expertise
Provider & Facility Enrollment Success
Claim Compliance Rate Across All Payers
Support Available for All Your Needs
Customized urology 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 going out as 45378 instead of 45385, and the PT modifier for screening conversions was being applied maybe 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 urology 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 from 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 underpaying 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 to ask for.
Practice Assessment
We audit your current urology 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 urology billing errors need to be addressed first.
Credentialing & Payer Enrollment
Every urology 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 payer, build a patient-level tracking system linked to the scheduling workflow, and confirm authorization status covers the specific procedure code before the patient is placed on the procedure schedule.
Clean Claim Submission
Our urology 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 the specific procedure documentation 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, urology billing turnaround time, and AR aging. Recurring billing errors are corrected at the charge entry level, not just addressed case by case.
Urology 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 all have to be right on every case. A general billing company handles the standard cases and misses the nuances. Credex Healthcare focuses on urology medical billing because this specialty requires billing specialists who work on urology claims every day and know where the revenue leaks sit.
Our team works on urology claims. We know how colonoscopy billing codes and modifiers work for screening versus diagnostic versus therapeutic cases, how add-on codes for biopsy and polypectomy apply to each base endoscopy code, and where urology billing errors most commonly recur in procedure documentation and charge capture workflows.
Your practice works with one dedicated urology billing specialist who knows your procedure mix, your payer contracts, your 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 urology billing turnaround time in monthly reports that reflect the actual financial position of the practice and the endoscopy facility.
Procedure reports, pathology results, and urology 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's facility and professional claims.
Urology practices lose revenue through billing patterns that persist for months before anyone identifies them. Polypectomy cases going out as diagnostic colonoscopies. Screening-to-therapeutic conversions missing the PT modifier. ERCP fluoroscopy add-ons not applied because the charge capture template did not prompt for them. An audit finds these patterns in the first few weeks and quantifies what they have cost.
Credex Healthcare will first give you a free review of your current urology 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 don’t have to make a promise to get that rating. We figure out the money that can be made back and the changes to the process that keep the same loses from happening in the next quarter.
Urology billing is the process of getting paid for urology expert services like endoscopies, office-based management and review visits, hepatology, and advanced urology services. Each treatment has a CPT code that is based on the endoscope method used and any changes that were carried out. This code is tied to an ICD-10 illness code that proves the procedure is medically necessary and must be filed with the correct modifiers and prior permission paperwork.
There are CPT numbers for upper endoscopy, colonoscopy, and other advanced treatments in urology. Upper urology endoscopy without biopsy is coded as CPT 43235. The upper endoscopy with biopsy is what CPT 43239 is. A diagnostic colonoscopy is what CPT 45378 is. 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.
Yes. Medicare, Medicaid, and private health plans all cover urology treatments when they are physically necessary and, in the case of colonoscopies, as a protective check. For people with average risk, Medicare pays for a screening colonoscopy every 10 years, and the person doesn’t have to pay anything extra for it. Before scheduling any treatment, Credex Healthcare checks to see if Medicare covers urology surgeries and checks to see what other payer-specific clearance requirements there are.
When all the paperwork for the operation is in order and the right numbers are used, Medicare processes clean electronic urology claims in 14 to 30 days. Commercial payers usually pay within 30 days as long as there is prior permission and a process report for every CPT code that was filed. Timelines for Medicaid vary by state, but are usually between 30 and 60 days. All three are looked at by Credex Healthcare’s pre-submission review before claims are sent in. This makes sure that most urology claims are processed within the normal time frame for urology billing.
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At Credex Healthcare, we know how frustrating it is when claims are denied. That is
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