Maximize reimbursements for colonoscopies, endoscopies, and infusion therapy with GI billing specialists who understand screening vs. diagnostic distinctions, polypectomy coding, modifier 53, and payer-specific coverage policies that commonly cause denials in GI practices.
Gastroenterology billing is among the most complex in outpatient medicine. Screening vs. diagnostic colonoscopy distinctions affect patient cost-sharing and payer billing rules. Polypectomy technique determines which CPT code applies. Infusion therapy has its own set of time-based billing rules. RCMAXIS GI billing specialists are trained exclusively in gastroenterology — our coders hold CPC and CGSC certifications and work through these complexities on every claim so your team doesn't have to.
Accurate CPT selection for diagnostic and therapeutic colonoscopies, EGD, flexible sigmoidoscopy, and enteroscopy — capturing all services performed during the encounter including biopsies and ablations, correctly distinguishing screening vs. diagnostic intent at the code and modifier level.
When a procedure must be discontinued, correct use of Modifier 53 is critical to secure partial reimbursement without triggering audits. Our team ensures documentation supports every modifier applied to GI claims — preventing both denials and compliance flags.
GI practices administering biologics, iron infusions, or hydration therapy face complex time-based billing rules. We accurately code initial versus sequential infusion hours, concurrent infusions, and therapeutic injections — capturing every billable unit correctly under CPT 96413, 96415, and related codes.
Polypectomy coding requires careful distinction between cold forceps, hot biopsy, snare technique, and endoscopic mucosal resection. We correctly code each removal method to maximize reimbursement while maintaining compliance with CMS and commercial payer guidelines.
Biologics, advanced endoscopy, and infusion therapies frequently require prior authorizations. RCMAXIS manages the full prior auth lifecycle — submission, follow-up, peer-to-peer coordination, and appeals — eliminating care delays and authorization-related claim denials.
GI denial patterns — medical necessity disputes for screening vs. diagnostic colonoscopy, bundling edits, and payer-specific coverage limitations — require targeted appeals. Our denial team analyzes root causes, corrects claims, and submits appeals with supporting documentation to recover your revenue.
Our certified GI coders stay current with annual CPT updates, CMS transmittals, and payer-specific policies to ensure accurate code selection on every claim.
General billing companies apply one-size-fits-all coding. GI practices are penalized by bundling edits, screening vs. diagnostic mismatches, and infusion coding errors that require specialty-specific expertise to prevent.
Our coders hold CPC and CGSC certifications and participate in ongoing GI-specific training. We understand endoscopy suite billing, ASC vs. office facility fees, and how each major payer handles GI procedure coverage — applying that knowledge to every claim we process.
High-volume endoscopy practices cannot afford billing delays. RCMAXIS processes and submits claims within 24 hours of receiving encounter documentation, keeping your AR days consistently below the national average.
Detailed monthly reports covering collections by procedure, denial rates and root causes, AR aging buckets, and payer-specific performance metrics — giving you full visibility into your practice's financial health without having to ask.
All data transmission, storage, and processing is fully HIPAA-compliant. Our team operates under strict BAAs, role-based data access controls, and regular security audits — protecting your patients and your practice at all times.