Gastroenterology Medical billing:

It is a sensitive billing process that requires an accurate inclusion of data to get the right reimbursement for the services rendered. This specialty billing exposes the practice to potential losses if the diagnostics and procedures are not properly coded.

Colonoscopies, for example, are at certain times tagged inappropriately as sigmoidoscopy procedures, because the documentation that is written to support the procedure only defines sigmoidoscopy technique. To properly define colonoscopy procedures, it is required for the coder to note the procedure as “advancement beyond the splenic flexure.”


Gastroenterology practices are commonly exposed to underpayments resulting from improper coding procedures. Gastroenterology requires a complex billing procedure that would properly identify the type of procedure done on a patient to ensure a fair and accurate payment.

At other times, gastroenterology’s requirements for billing exceeds what medical billing software can do, and as a result, gastroenterology practices enlist the services of medical billing firms to assist in the practice’s billing procedures.

Common Medical billing issues:

Eligibility verification.

Update System to EMR/HER

Failing to Keep Up with CPT Updates

Documentation and medical necessity

Improper Use of Modifiers – Modifiers 51 and 59 are often confused

Keep Regular Compliance Sessions

Gastroenterology billing and coding is both complex and challenging, and perhaps nothing else has such a huge impact on your revenue cycle. Accurate, efficient billing and coding can accelerate your billing cycle and increase revenues, while mistakes in this area can result in lost revenues due to paybacks, denials, and under-coding. Here’s a closer look at some of the most GI billing and coding mistakes, important tips to follow to prevent mistakes and improve revenue, and new changes coming for the specialty in 2019


Gastroenterology medical billing is a highly specialized business, make sure you have CareMB experts doing it for you