GI claims depend on why a scope was done (screening, diagnostic or therapeutic), and that can change mid-procedure.
Examples of frequently billed services, with billing notes from our coders.
| CPT code | Service | Billing note |
|---|---|---|
| 45378 | Colonoscopy, diagnostic | Becomes screening or therapeutic by findings and payer |
| 45380 | Colonoscopy with biopsy | Do not bill with 45378 |
| 45385 | Colonoscopy with polyp removal by snare | Use the most extensive technique |
| G0121 | Medicare colonoscopy screening, average risk | Frequency rules apply |
| 43235 | Upper endoscopy (EGD), diagnostic | Biopsy and therapy have their own codes |
| 43239 | Upper endoscopy with biopsy | Link diagnosis to each biopsy |
| 91110 | Capsule endoscopy of the digestive tract | Check payer policy and authorization |
Codes shown are common examples and descriptions are simplified in our own words. CPT® is a registered trademark of the American Medical Association. Always confirm against the current AMA CPT codebook, ICD-10-CM and each payer’s policy.
Modifiers tell the payer how and why a service was performed. Missing or wrong ones are a leading cause of denials.
Eligibility, benefits and prior authorization verified before the visit.
Code, modifier and documentation review before claims are submitted.
Denials corrected and appealed, aging claims worked until resolved.
Diagnostic testing, procedures and E/M claims coded correctly for each payer.
View billing detailsBiopsy, lesion removal and Mohs billing, with medical and cosmetic claims kept separate.
View billing detailsSurgical coding with laterality, modifiers and global periods handled properly.
View billing detailsTalk to our team about your practice, hospital or lab. We will review your current billing and show you where revenue is slipping away.