Gastroenterology Billing Services for Digestive Care Practices

Screening colonoscopies, therapeutic endoscopy, IBD infusions, and hepatology visits each follow distinct payer rules. Our gastroenterology billing services help GI physicians submit well-supported claims.

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Gastroenterology Billing Services Shaped by Endoscopy

Gastroenterology billing services start with the procedure report. A single colonoscopy can begin as a screening, turn diagnostic when a polyp appears, and end with snare removal at one site and cold biopsy at another, and each detail changes the codes, modifiers, and patient cost share. Pyramids Global assigns certified coders to your account who read endoscopy and pathology findings line by line, so every GI claim reflects the screening intent, the therapeutic work, and the setting where your gastroenterologists performed it.

Gastroenterologist discussing results with a patient

Why GI Claims Need a Closer Look Than Most Specialty Billing

Endoscopy nurse and physician preparing equipment before a colonoscopy

Gastroenterology blends office visits, endoscopy, infusions, and long-term liver and bowel care, and payers treat each one differently. Medicare covers colorectal cancer screening from age 45, and a follow-on colonoscopy after a positive stool-based test is now treated as screening rather than diagnostic. When a screening procedure turns therapeutic, modifiers such as PT or 33 shape what the patient owes. The multiple endoscopy rule reduces payment for related codes in one session, and professional claims must match ASC or hospital records. Before claims go out, our gastroenterology billing services check these points, so each case follows the right rules.

Billing specialist reviewing GI procedure claims on a computer

Where Gastroenterology Revenue Slips Away – and How We Address It

GI practices perform a high volume of procedures, so a small coding gap repeats quickly across many patients. Our gastroenterology billing services focus on the four areas where those losses tend to begin:

Screenings That Turn Diagnostic

A screening colonoscopy that finds and removes a polyp still begins as preventive care. Medicare claims need modifier PT, and many commercial plans expect modifier 33 to show preventive intent. When these are missing, cost share may be applied in error and patient disputes follow. Our coders confirm intent first.

Bundled Endoscopy Code Families

When biopsy, polypectomy, and dilation happen during one EGD or colonoscopy, the multiple endoscopy rule and NCCI edits decide how each code is paid. Different techniques at separate lesions may need modifier 59 or XS. We sequence codes within each family and tie them to the procedure note.

Incomplete and Reduced Procedures

A colonoscopy that stops short of the cecum because of poor prep or an obstruction is not reported like a complete study. Medicare guidance calls for modifier 53 in many such cases, and a repeat study needs clear records. We check each report for the extent of the exam first.

Infusion Drugs and Waste Reporting

IBD biologics such as infliximab and vedolizumab require exact billing units, NDC details, and infusion time codes. Medicare also expects the JW or JZ modifier on single-dose vials to show whether any drug was discarded. Our team checks units and authorizations before each infusion claim.

Inside Our Gastroenterology Billing Services, From Referral to Payment

Each GI case follows one path with our team, from referral and benefit review through the procedure, pathology results, payment posting, denial follow-up, and any remaining patient balance.

Endoscopy, Sedation, and Visit Coding

Our coders assign EGD, colonoscopy, ERCP, and capsule endoscopy codes from the report, add moderate sedation codes when the endoscopist provides it, and link final diagnoses to pathology results. Office consults and follow-ups are leveled by MDM or total time.

Benefit Checks Before Every Procedure

Ahead of each scheduled case, we confirm coverage, screening frequency limits, prior colonoscopy dates, and patient cost share, so your front desk can share sound estimates with patients and plan schedules before the procedure day.

Unpaid Claim Recovery and
Appeals

When a GI claim comes back unpaid, our team traces the reason, fixes the coding or documentation gap, and files an appeal with the procedure report attached. Patterns tied to one payer or code appear in your monthly report.

More Physician Time in the Procedure Room

Gastroenterologists move between clinic, endoscopy suite, and hospital consults in a single day. With coding and follow-up handled by our team, your physicians can keep their focus on patients and findings.

What GI Groups and Endoscopy Centers Gain From Our Billing Team

Pyramids Global works with more than 500 medical practices across the United States. For independent gastroenterologists, GI groups, and endoscopy centers, our gastroenterology billing services offer:

Certified Coders for GI Procedures

Our coders handle endoscopy code families, screening rules, infusion billing, and hepatology visits each day, and they review the yearly CPT and Medicare changes that affect GI claims.

An Account Manager for GI Teams

Your practice works with one account manager who knows your physicians, procedure locations, and payer contracts, so each question reaches a person who understands your workflow.

ASC and Hospital Claims in Sync

GI procedures at an ambulatory surgery center or hospital outpatient department need professional claims that match the facility record. We verify dates, codes, and place of service.

Reports by Physician and Procedure

Monthly dashboards show collections, denial causes, A/R aging, and procedure volume for each gastroenterologist and location, giving leaders a reliable base for decisions.

Results Measured Across Clients

Among the practices we serve, coding accuracy averages 98%, first-pass claim acceptance runs near 99%, and about 86% of payments typically arrive within 30 days of submission.

Our Accuracy Checks for Gastroenterology Claims

GI procedure reports often list several findings, techniques, and sites in one session, and the final diagnosis may depend on pathology that arrives days later. Our coders review procedure codes, modifiers, sedation, and diagnosis links on each gastroenterology claim before submission, which helps stop one error from repeating.

Practices using our gastroenterology billing services get documented coding decisions, monthly visibility into payer behavior, and organized records for audits or payer reviews. The aim is billing that stays clear across screening programs, therapeutic endoscopy, infusion care, and long-term liver and bowel disease management.

Pyramids Global coders checking gastroenterology billing services reports

Additional Revenue Cycle Help for Gastroenterologists

GI revenue also relies on timely approvals, precise coding, and up-to-date credentialing, and the American Gastroenterological Association publishes coding and policy updates that guide how digestive care is reported. Alongside these gastroenterology billing services, our team offers:

- Certified medical coding services for endoscopy reports, infusion visits, hepatology care, and consults

- Prior authorization services for capsule endoscopy, biologic infusions, and imaging, usually started within 30 minutes of an order

- Credentialing services for gastroenterologists and PAs with Medicare, Medicaid, and commercial plans in 21 states

- Premium Practice Audit that reviews claims for missed modifiers and underpaid endoscopy procedures

Gastroenterology Billing Services – Common Questions From GI Practices

What does Pyramids Global charge for gastroenterology billing services?

Pricing depends on your procedure volume, payer mix, and the services you choose, and there are no setup fees. During a consultation, our team reviews your practice details to suggest a fitting plan.

Which GI procedures and services does your team bill?

We bill EGD, colonoscopy, flexible sigmoidoscopy, ERCP, EUS, capsule endoscopy, and esophageal motility studies. We also bill office and hospital consults, IBD biologic infusions, FibroScan and hepatology visits, in-office procedures, and telehealth follow-ups.

How is a screening colonoscopy billed when a polyp is removed?

It remains a screening service at its core. Medicare claims add modifier PT to the therapeutic code, and many commercial payers use modifier 33. Since 2023, Medicare has been gradually phasing down the patient coinsurance for these cases.

Do you handle prior authorizations for GI procedures and infusions?

Yes. Our team usually begins each request within 30 minutes of receiving the order. Payers often decide urgent requests in 24 to 72 hours, while standard reviews can run from about seven to fourteen days or longer.

Will our practice need a new EHR or endoscopy software?

No. Our billers work inside the EHR and endoscopy reporting systems you already use, so physician workflows stay the same. A Business Associate Agreement is signed with every practice, and patient data is handled under HIPAA.

How do we follow performance after onboarding?

Monthly reports show collections, denial reasons, procedure volume, and open balances, so you can compare results from one month to the next.

Schedule a Consultation to Review Your GI Billing Performance

Gastroenterology practice manager meeting with a billing consultant

Screening denials, cost-share disputes, or slow infusion payments are signs that a GI billing workflow needs review. Our gastroenterology billing services begin with a look at recent claims, payer responses, and A/R. Since 2013, Pyramids Global has supported more than 500 practices across 20+ specialties, and a consultation is the first step to see where your GI claims stand.

Our team can take on endoscopy and visit coding, benefit checks, authorizations, infusion billing, payment posting, appeals, and accounts receivable follow-up across office, ASC, and hospital settings. That gives your gastroenterologists and staff more room for procedures, patient education, and ongoing digestive care.

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