Overview

Why Gastroenterology Requires Specialized Expertise in Billing

Gastroenterology (GI) medical billing is considered to belong to the most complex and high-compliance revenue cycle management areas because of the diverse nature of diagnostic, screening, and treatment services.

From colonoscopies and endoscopies to more advanced procedures such as ERCP (Endoscopic Retrograde Cholangiopancreatography) and capsule endoscopy, GI practices must manage multi-level codes, modifiers, and payer-specific regulations to ensure proper reimbursement.

At NexCure LLC, when we code, document, and submit services, each service is done in accordance with AAPC guidelines so that our billers are credible and billing is clean, resulting in timely payments. We partner with ambulatory surgery centers (ASCs), GI practices, and hospitals to ensure revenue and compliance success.

Get a Free Audit
Contact Us

    Request A Quote

    The gastroenterology coding includes, in comparison to primary care billing:

    Repeated application of CPT codes with different uses in case of screening and diagnostic procedures, Separating two procedures conducted for both preventive care and active medical conditions, Understanding Medicare policies and commercial payer coverage including same-day care, anesthesia payments, and pathology add-ons, Handling high claim denial rates due to poor documentation, incorrectly assigned diagnosis, or missing modifiers.

    Major Issues

    The Major Issues of Gastroenterology Billing

        • Medicare and commercial payers have different reimbursement rules for screening colonoscopies.
        • A screening that leads to polyp removal changes the patient cost-sharing requirement and coding.
        • Improper coding can cause patient dissatisfaction and rejection of preventive service coverage.
        • Modifiers such as -33 (preventive services), -PT (colorectal cancer screening converted to diagnostic), and -59 (distinct procedural service) are critical.
        • Missing or misapplied modifiers are among the most frequent reasons for denials and underpayments in GI billing.
        • GI specialists often perform multiple procedures the same day, such as colonoscopy with biopsy and polyp removal.
        • Correct bundling and unbundling are necessary to prevent compliance failures and revenue loss.
        • Many GI procedures require pathology services.
        • Proper coordination between GI practice and pathology lab ensures accurate claim linking and correct reimbursement.
      • Advanced GI procedures like endoscopy, esophageal manometry, and ERCP usually require prior authorization.
      • Failure to obtain authorization can result in a 100% loss of payment for such services.

    The Advantages of Partnering with NexCure LLC for GI Billing

    By choosing NexCure LLC as your gastroenterology billing partner, you benefit from:

    Superior Collections Rate

    We minimize denials and
    maximize reimbursements.

    Faster Reimbursements

    Thanks to clean claims and timely submissions.

    Compliance-Based Processes

    We follow CMS, Medicare, and commercial payer requirements.

    Reduced Administrative Load

    Let your staff focus on patient care while we handle billing.

    Full-Service Reporting

    Monthly revenue cycle reports highlighting trends, denials, and growth opportunities.

    NexCure LLC – End-to-End Gastroenterology Billing Services

    We offer comprehensive GI billing services that address these challenges and streamline your revenue cycle.

    Expert GI Coding & Documentation

  • Experienced in CPT, ICD-10, and HCPCS gastroenterology coding.
  • Competent coding for:
    • Colonoscopy (45378–45385 series)
    • Esophagogastroduodenoscopy (EGD) procedures
    • ERCP & EUS
    • Flexible sigmoidoscopy
    • Capsule endoscopy
    • Motility and dilation testing
  • Documentation that reinforces medical necessity for every service.

    • Modifier Compliance

  • Correct use of modifiers (-33, -PT, -59, -26, -TC) to maximize revenue while staying compliant..
  • Avoiding overuse that could trigger audits.

    • Prior Authorization Administration

  • Clearing payer requirements and obtaining pre-approvals for high-cost GI procedures.
  • Maintaining authorization logs to prevent reapplication delays.

    • Eligibility & Diagnosis Verification

  • Checking preventive vs. diagnostic procedures before the date of service.
  • Confirming deductible, coinsurance, and copay obligations to minimize disputes.

    • Clean Claim Submission

  • Real-time electronic error-checking for claims.
  • Avoiding rejections by following payer-specific billing guidelines.

    • Denial Management & Appeals

  • Tracking denial trends related to modifiers, bundling issues, and medical necessity.
  • Writing well-documented appeals using clinical evidence.

    • Payment Posting & ERA Reconciliation

  • Posting payments accurately to detect underpayments.
  • Matching payer ERA adjustments against contracted rates.

    • Patient Billing Support

  • Providing clear, easy-to-read statements.
  • Offering patient-friendly payment plan options.

    • Why GI Billing Errors Are Expensive

    Even a single mistake in a modifier or diagnosis linkage can cost hundreds to thousands of dollars. For example:

    • Failing to use -PT when a screening colonoscopy becomes diagnostic can shift the full cost to the patient, causing dissatisfaction and complaints.
    • Incorrect procedure bundling can result in payers recouping payments months later.

    When you work with NexCure LLC, you avoid these risks by ensuring every claim is accurate, compliant, and supported by documentation

    Standard GI Procedures We Bill

    Screening/Diagnostic Colonoscopy

    EGD (with/without biopsy)

    ERCP

    PH/manometry studies

    Capsule endoscopy

    Flexible sigmoidoscopy

    Esophageal dilation

    PEG insertion

    Hemorrhoid banding

    Polypectomy & biopsy

    Why Partner with NexCure LLC

    Why Choose NexCure LLC for Gastroenterology Billing?

    • AAPC-certified coders specializing in gastroenterology.
    • 100% HIPAA-compliant operations.
    • Proven history of 30–50% reduction in denials.
    • Flexible pricing models for single practitioners, large GI groups, and ASCs.

    Start Today

    Billing in gastroenterology doesn’t have to be stressful. With NexCure LLC, you’ll see:

    • Improved cash flow
    • Reduced denials
    • Better compliance

    Contact us today for a free onboarding consultation and discover how we can help your GI practice thrive.

      Request A Quote

      Client Testimonials

      What Healthcare Providers Say About Us

      "Working with NexCure LLC has been a relief for my clinic. They took care of my credentialing process from start to finish, no delays, no confusion. I also like how they keep up with CMS quality programs and explain things clearly. Honestly, they’ve made my life much easier."

      Dr. Ayesha Rahman, MBBS

      "Before NexCure LLC, our billing was a nightmare — denials, delays, you name it. Their team stepped in and fixed our revenue cycle quickly. What I appreciate most is their guidance on MIPS reporting; they walked my staff through the requirements and we’ve already seen the results. Dependable and professional."

      Dr. James Whitman, MD

      "The attention to detail at NexCure LLC is impressive. They helped us get credentialed with several payers and made sure everything stayed compliant. Their support with HEDIS reporting boosted our scores, which directly benefited our contracts. I’m grateful for their hard work."

      Dr. Maria Gonzalez, MD

      "I’ve been very satisfied with the services from NexCure LLC. They keep me updated on payer rules and compliance, which is something many billing companies overlook. My billing cycle is smoother now, and their assistance with MIPS reporting has been a real plus. It feels like they are part of my team."

      Dr. Omar Al-Farouq, MD

      "Our practice needed someone who really understood billing and coding. NexCure LLC improved our collections and made the whole process less stressful. They’re straightforward, easy to reach, and they actually deliver on what they promise. I recommend them without hesitation."

      Dr. Alejandro Ramirez, DO
      12+

      Years of Expertise in Medical Billing & Revenue Cycle Management

      85+

      Providers Across Multiple Specialties Trust NexCure LLC Consultancy

      97%

      Clean Claims Rate Achieved on First Submission of Project Delivery

      15K+

      Claims Accurately Processed Every Month

      Book Consultation

      (929) 587-3833

      Email address:

      Info@nexcurellc.com

      1500 N Grant ST #5001, DENVER, CO, 80203

      United States

      WhatsApp:

      (929) 587-3833

        Get Free Practice Audit