Gastroenterology
Gastroenterology Medical Billing and Coding Solutions
Master gastroenterology billing and coding with AI agents specialized in endoscopy CPT bundling, pathology specimen rules, IBD/hepatology ICD-10 specificity, and payer-specific prior authorization workflows.
What Is Gastroenterology Billing and Coding?
Gastroenterology billing and coding involves converting office visits for GI symptoms, diagnostic and therapeutic endoscopies (EGD, colonoscopy, ERCP), and chronic disease management (IBD, GERD, hepatitis) into accurate, payable claims.
Coders assign precise CPT codes for endoscopic procedures with appropriate base and add-on codes, apply NCCI bundling rules for biopsies and polypectomies, select detailed ICD-10 codes for conditions like K50 (Crohn's), K51 (ulcerative colitis), and K21 (GERD), and ensure modifiers are applied correctly for multiple procedures and anatomical sites.
Billers verify eligibility, secure prior authorizations for advanced procedures (capsule endoscopy, liver biopsies), manage pathology specimen charges, submit clean claims, and appeal denials for medical necessity and bundling issues.
Endoscopy Bundling and Add-On Codes
Colonoscopy, EGD, and ERCP require precise base code selection and add-on codes for biopsies, polypectomies, and hemostasis; NCCI edits bundle many combinations.
Impact: Missed revenue from incorrectly bundled procedures
Pathology Specimen Coordination
Endoscopic biopsies generate separate pathology charges (88305) that must be coordinated with procedural codes and tracked across facilities.
Impact: Pathology billing delays and lost charges
ICD-10 Specificity for GI Conditions
IBD, GERD, hepatitis, and liver diseases require laterality, severity, and episode details (K50.10 Crohn's, K70 alcoholic liver disease) that are often vaguely documented.
Impact: Medical necessity denials and LCD non-compliance
Our Expertise in Gastroenterology Billing and Coding
Amy: AI Medical Coding Agent for Gastroenterology Care
- Codes endoscopies (EGD, colonoscopy, ERCP) with precise CPT base and add-on codes, ICD-10 combinations for IBD (K50/K51), GERD (K21), and liver diseases
- Applies NCCI bundling rules, modifier 59/XE for separate procedures, and multiple site rules
- Flags missing biopsy details, polyp locations, and severity documentation
- Audits charts for screening vs diagnostic colonoscopy distinctions, pathology coordination, and quality metrics
- Provides line-by-line rationale for each code ensuring compliance and audit transparency
Mark: AI Medical Billing Agent for Gastroenterology Care
- Verifies eligibility across Medicare, Medicaid, and commercial payers for screening, diagnostic, and therapeutic procedures
- Validates GI-specific codes, bundling edits, and medical necessity before submission
- Submits claims and handles charge entry directly in your EHR/billing system
- Reads ERAs and scans paper EOBs to post payments and catch underpayments for endoscopic services
- Continuously learns from gastroenterology denial patterns like CO-97 (bundling), CO-50 (medical necessity), and screening vs diagnostic disputes
Adam: AI Denial Management Agent for Gastroenterology Care
- Checks claim status in real-time across payers for high-value procedures like ERCP, capsule endoscopy, and liver biopsies
- Makes AI-driven calls navigating IVRs and agents for prior auth disputes and bundling appeals
- Uses customizable scripts tailored to gastroenterology workflows, including screening conversion disputes, polyp tracking, and IBD medication PA
- Manages outbound/inbound calls with full call tracking
- Provides recordings, summaries, and recommendations to resolve aging GI claims faster
What are the common reasons for gastroenterology claim denials?
How do colonoscopy CPT codes work?
What is the screening vs diagnostic colonoscopy distinction?
What ICD-10 codes are most used in gastroenterology?
How can AI improve gastroenterology coding accuracy?
Future-proof your Healthcare RCM with AI Workforce
Schedule a Call with Us to Discuss Your Needs
Email: info@combinehealth.ai
Internal Medicine
Critical Care
Pediatrics
Emergency Medicine
Anesthesiology
Dermatology
Neurology
Radiology
Psychiatry
Pathology
Family Medicine
Orthopedics
Gastroenterology
Ophthalmology
General Surgery
Obstetrics and Gynecology
