MedCare Billing Solutions specializes in gastroenterology billing for GI practices, endoscopy centers, and hospital-based gastroenterologists. Our AAPC-certified coders know every colonoscopy bundling rule, ERCP add-on code, and polyp removal modifier — so you collect every dollar you've earned.
Gastroenterology procedure codes are loaded with bundling edits, add-on code requirements, and modifier nuances. GI practices with non-specialized billing staff routinely leave 12–20% of revenue uncollected due to:
The average 3-physician GI practice leaves $200,000–$450,000/year in uncollected revenue due to colonoscopy miscoding, missing polyp removal add-ons, and unbilled infusion therapy. MedCare's GI billing specialists close that gap.
Our GI-specialized coders handle every endoscopy, colonoscopy, and infusion therapy code with precision.
| CPT Code | Procedure | Common Billing Issue |
|---|---|---|
| 45378 | Colonoscopy, diagnostic/screening | Used when polyp found — should be 45380/45385; reduces revenue by $200+ |
| 45380 / 45385 | Colonoscopy with biopsy / polypectomy | Wrong technique code; missing hot biopsy (45381) add-on |
| 45390 | Colonoscopy with EMR | Underbilling when EMR performed instead of standard polypectomy |
| 43239 / 43259 | EGD with biopsy / EUS | Wrong approach code; EUS add-ons (43237/43238) missed |
| 43260–43278 | ERCP with interventions | Base code only; add-on codes for sphincterotomy/stent not billed |
| 91110 | Capsule endoscopy (small bowel) | Prior auth not obtained; missing interpretation documentation |
| 96365 / 96413 | IV infusion therapy (biologics) | Wrong code for drug type; missing add-on time units (96366/96367) |
| 43770–43775 | Laparoscopic bariatric procedures | Missing facility vs. professional split billing for ASC cases |
Real-time eligibility verification and prior authorization management for colonoscopies, capsule endoscopy, infusion therapy, and advanced GI procedures.
AAPC-certified coders with GI subspecialty expertise. We handle office visits, endoscopy center procedures, hospital-based GI, and infusion therapy billing.
Electronic claim submission within 24 hours of charge entry. Claims scrubbed against GI-specific NCCI edits and payer LCD policies before every submission.
Specialized GI denial appeal team. We fight screening vs. diagnostic colonoscopy conversions, medical necessity denials, and infusion authorization issues.
Aggressive accounts receivable management. We keep your 90+ day AR below 10% — industry average for GI practices is 31%.
We handle both professional and facility billing for GI practices with their own endoscopy center or ASC — maximizing revenue from both revenue streams.
Get a free, confidential GI billing audit. We'll review your colonoscopy coding, infusion billing, and denial patterns — and show you exactly what you're leaving on the table.