Gastroenterology
Healthcare IT and billing built for a gastroenterology practice
Endoscopy scheduling, screening versus diagnostic colonoscopy logic and pathology tracking for GI practices.
Why gastroenterology is different
The most consequential distinction in GI billing is whether a colonoscopy is screening or diagnostic. It determines patient cost-sharing, the modifier applied, and whether the patient receives an unexpected bill that generates a complaint.
Healthcare SBC builds that logic into the workflow, along with endoscopy scheduling, ASC billing, specimen tracking through pathology, and the surveillance recall that keeps patients on interval.
Common challenges
Where gastroenterology practices lose revenue
The billing and workflow problems specific to this specialty, and the ones generic systems handle badly.
Screening versus diagnostic determination
A screening colonoscopy that becomes therapeutic changes coding, modifiers and patient responsibility mid-procedure.
Patient cost-sharing surprises
Incorrect screening coding produces unexpected patient bills, complaints and collection problems.
ASC and facility billing
Practices with an endoscopy center must bill professional and facility components under different rules.
Surveillance interval tracking
Recall intervals based on findings must be tracked for years to keep patients on appropriate surveillance.
How we address it
Built for gastroenterology workflows
- Screening versus diagnostic coding logic with correct modifier application
- Pre-procedure benefit verification and patient cost estimation
- Integrated endoscopy scheduling with prep instruction delivery
- ASC facility billing alongside professional claims
- Findings-based surveillance recall tracking and automated outreach
Commonly billed codes in gastroenterology
A sample of the codes our gastroenterology coders work with daily.
- 45378Colonoscopy, diagnostic
- 45380Colonoscopy with biopsy
- 45385Colonoscopy with polypectomy, snare technique
- G0121Screening colonoscopy, not high risk
- 43239Upper GI endoscopy with biopsy
Codes shown for reference only. Verify against current code sets and payer policy.
Other medical specialties
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Dermatology
High-volume visit throughput, lesion documentation and pathology tracking for medical and cosmetic dermatology.
Obstetrics & Gynecology
Global obstetric packages, prenatal tracking and gynecologic procedure billing on one platform.
FAQ
Gastroenterology, frequently asked questions questions
- How do you handle a screening colonoscopy that becomes diagnostic?
- When a polyp is found and removed during a screening exam, the procedure is coded as therapeutic with modifier PT (or payer-equivalent) to preserve the screening benefit where the payer allows it. Our coders apply the correct convention per payer, which directly affects patient cost-sharing.
- Can you bill both professional and facility components?
- Yes. Practices operating an ASC or endoscopy center can bill facility claims alongside professional claims from the same platform, with appropriate revenue codes and separate contract management.
- Does the platform track surveillance intervals?
- Yes. Recommended intervals are recorded from procedure findings, and automated recall outreach brings patients back on schedule: protecting both outcomes and recurring procedure volume.
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