Some medical fields are hard to code. Gastroenterology is one of those challenging fields and one of the busiest outpatient surgery specialties. Have you ever thought about what happens when coding is done wrong? Well, getting Gastroenterology coding right is more complicated for healthcare professionals.

Even if you’re generally good at coding, healthcare pros often need to pay attention to necessary info or documents. Mistakes in billing and coding lead to less money coming in. Regarding Gastroenterology coding and billing, let’s talk about why the money you get back is less.

Here are five common mistakes in gastroenterology coding

Below are the most common mistakes related to gastroenterology coding, at the end of the blog, you will also learn how getting gastroenterology billing services can help you overcome these issues. 

  • Using the wrong modifiers.
  • Charging too much.
  • Not keeping up with CPT code changes.
  • Checking if patients are eligible for coverage.
  • Not documenting properly and showing medical necessity.

Inaccurate Modifiers

  • One big mistake in Gastroenterology coding happens with the wrong modifiers.
  • Most errors come from mix-ups between modifiers 51 and 59 in endoscopic coding.
  • Modifier 51 is used when two different procedures are done on the same day in Gastroenterology coding.
  • The American College of Gastroenterology recommends listing codes with the highest value due to a rule for multiple procedures.
  • Modifier 59, on the other hand, is used for different procedures or sites on the same day.
  • The American Gastroenterology Association offers hot biopsy polypectomy for one lesion and cold biopsy for another.
  • Insurance companies are more likely to pay for these procedures when you use modifier 59 in Gastroenterology coding.
  • Mixing up modifiers 51 and 59 can lead to your claims being rejected or denied.


  • More and more people are checking how they evaluate and manage code.
  • Both new and existing gastroenterology procedures can use evaluation and management codes.
  • New patients get more money because it takes more time, as Centers for Medicare and Medicaid Services said.
  • If an existing patient is coded at the new patient level, it’s called upcoding for their office visit.

Important News About CPT Codes

Every year, the American Medical Association changes CPT codes. This means they make over 300 updates to how doctors and specialists code procedures.

Some of the old codes are going away. They’re being replaced with new regulations, which are crucial for gastroenterology.

Doctors and medical billers need to know about these new codes. This way, they can avoid problems with insurance claims for gastroenterology procedures.

When using CPT codes, it’s crucial to add the right modifiers. These modifiers help explain to insurance companies why a procedure was done and what kind of procedure it was

Eligibility Verification

  • Making sure patients are eligible for gastroenterology procedures is essential for billing and coding.
  • Even though the front office staff isn’t directly involved in eligibility checks, they play a significant role in avoiding claim rejections.
  •  Many claims get denied if the front office staff isn’t knowledgeable about billing and coding changes.
  • The front desk team must gather patient info and confirm if their insurance covers the procedure.
  • Creating solid processes and focusing on patient insurance details is essential to prevent revenue loss and get more money back.

Problems with Documents and Proving Medical Need

  • We need better, precise paperwork to ensure our business stays profitable.
  • Clear paperwork with the right details is essential for correct billing and coding. This means fewer errors when we send claims.
  • Insurance companies want precise paperwork and proof that medical care is necessary.
  • Insurance companies ask for patient records to check if maintenance is needed. Healthcare professionals may need more time to be fully ready for this.
  • If healthcare pros don’t use electronic health records (EHR), they might have trouble when insurance companies want to see documents showing medical needs.
  • Even if healthcare pros use EHR, they may still worry about having wrong or unnecessary info in the papers.

Essential tips for gastroenterology coding:

  • Always remember, they don’t charge extra for stopping bleeding.
  • Many endoscopic and gastroenterology procedures are about stopping bleeding.
  • They only charge for stopping bleeding separately when the patient is admitted with GI bleeding and the endoscopy is done.
  •  Learn the difference between diagnostic and endoscopic procedures and screening colonoscopies.
  •  You can use ICD-10 codes for screening colonoscopies.
  • When screening colonoscopies to find and remove polyps, you need special modifiers for Medicare.

Outsourcing gastroenterology medical billing can be the solution

Outsourcing gastroenterology medical billing is a viable solution. It allows healthcare providers to focus on patient care while experts handle the complex and ever-changing billing and coding regulations. Outsourcing has always been profitable for doctors, primary care clinics, and big healthcare organizations. 

Professional medical billing companies have the knowledge and experience to maximize revenue by ensuring accurate coding, reducing claim denials, and improving the overall billing process efficiency. This can lead to increased revenue, reduced administrative burdens, and enhanced compliance with industry standards. Outsourcing gastroenterology practices can improve their financial health and streamline operations, ultimately providing better patient care.

Final Thoughts

Medical billing and coding are complex and require time and attention while doctors are busy in their practices. More often, due to hectic and patient overload, they have less time for financial management. However, outsourcing can help healthcare organizations avoid burnout.