PGM: Gastroenterology Medical Billing Experts
Connect with PGM today to learn why gastroenterology practices across the country trust us with their billing. Speak directly with a gastroenterology billing expert who will explain how our tailored approach helps maximize revenue, minimize operational costs, and improve financial performance.
When it comes to GI revenue operations, practices have options — but more and more are choosing PGM for our deep expertise, responsive service, and proven results.
What can PGM do for your gastroenterology practice’s bottom line? Let’s find out together.
PGM Billing: The Gastroenterology Medical Billing Company
The field of gastroenterology demands specialized billing expertise. From diagnostic endoscopies to complex GI procedures, accurate and compliant CPT and ICD-10 coding is essential for timely reimbursements and financial stability. At PGM Billing, we provide comprehensive gastroenterology coding and billing solutions tailored to the unique needs of GI specialists.
Our end-to-end services — from claim submission and denial management to payer compliance and reporting — are designed to optimize every stage of your gastroenterology revenue cycle. Whether you’re using a legacy system or seeking a cutting-edge GI billing software, PGM helps you streamline your process, reduce errors, and boost revenue.
Why Gastroenterology Billing and Coding Is Exceptionally Complex
One of the most significant challenges in GI billing services lies in the wide variability of reimbursement protocols among insurance payers. This is particularly true when billing for high-volume and sometimes high-complexity procedures such as colonoscopies, endoscopies, biopsies, and advanced GI diagnostics. Each payer maintains its own unique rules on how procedures must be coded, what documentation is required, and how services are reimbursed. For instance, some insurers fully reimburse for bundled GI procedures, while others reduce payment or require separate authorizations, creating confusion and potential payment delays.
Without in-depth knowledge of commercial and federal payer-specific rules, practices risk revenue loss from denials, underpayments, or billing errors. These issues not only affect cash flow but can compromise long-term financial sustainability.
Navigating Medicare Requirements in Gastroenterology Medical Billing
For GI practices that accept Medicare, the complexities increase. Billing for Medicare involves highly specific coding guidelines, strict bundling rules, and frequent regulatory updates. Services such as diagnostic colonoscopies and therapeutic interventions are subject to unique documentation and reimbursement thresholds under CMS regulations.
Failure to comply with Medicare’s requirements can lead to denied claims, compliance audits, and potential penalties. That’s why many practices rely on expert GI medical billing companies like PGM to ensure every claim is submitted accurately, compliantly, and on time.
Comprehensive Gastroenterology Billing and Coding Services by PGM
At PGM, we specialize in delivering end-to-end GI billing services designed to ensure full compliance, reduce denials, and maximize revenue. Our team understands the intricacies of GI medical billing, helping practices navigate complex payer rules and streamline GI revenue operations for stronger financial outcomes. Whether you’re an independent GI specialist or part of a larger group practice, outsourcing your GI medical billing services to PGM means gaining a partner committed to accuracy, transparency, and consistent results.
GI Procedure Billing and Coding
Billing for gastrointestinal procedures such as colonoscopies, upper endoscopies (EGDs), polyp removals, and capsule endoscopies requires exact coding and thorough documentation. PGM ensures proper use of CPT and ICD-10 codes to reflect the service provided, its medical necessity, and any related diagnoses. We account for payer-specific rules on frequency limits, pre-authorizations, and bundling, helping to prevent common revenue-draining mistakes.
Gastroenterology CPT Coding Expertise
Accurate CPT coding is at the core of effective, accurate gastroenterology coding and billing that lead to clean claims and correct, timely payments. With numerous procedure variations and diagnostic complexities, even minor coding errors can lead to significant revenue loss. PGM’s certified coders are experts in applying the correct CPT codes for services such as diagnostic colonoscopy (45378), diagnostic upper GI endoscopy (43235), colonoscopy with polypectomy (45385), and wireless capsule endoscopy (91110).
Modifier Management for Complex GI Cases
Modifier usage plays a critical role in GI medical billing when multiple services are performed in the same session. Our team ensures accurate application of modifiers such as -59 to distinguish separate procedures, -51 for multiple procedures, and -26 and -TC to identify professional and technical components. This careful approach minimizes denials and ensures that every component of care is reimbursed appropriately.
ICD-10 Code Selection for GI Conditions
From GERD (K21.9) and Crohn’s disease (K50.90) to colorectal cancer screenings (Z12.11), proper ICD-10 coding is essential for documenting medical necessity and meeting payer guidelines. Our coders stay up to date on evolving coding standards to maintain full compliance and support accurate reimbursement across all payers.
The Results: Maximized Reimbursement & Compliance
PGM has a proven history of helping gastroenterology practices increase revenue, reduce billing errors, and stay compliant. By leveraging our specialized GI billing services, clients consistently see a 20–30% improvement in collections, a 40% drop in claim denials, and noticeable gains in billing efficiency. Our expertise as a trusted GI medical billing company delivers real, measurable results.
How PGM Delivers the Best Gastroenterology Billing Service
PGM stands out among GI medical billing companies thanks to our data-driven strategies, advanced technology, and a team of dedicated billing experts. Our ability to consistently deliver superior results is built on the following key strengths:
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Complete Gastroenterology Billing Services
We offer full-service gastroenterology coding and billing, from claim submission to denial management and payment posting, ensuring accuracy and efficiency at every step. -
Gastroenterology Billing Software Integration
Our specialized GI billing software streamlines workflows, automates coding and charge capture, and reduces human error to help practices collect more, faster. -
Advanced Payer Negotiation Strategies
We engage directly with payers to negotiate fair reimbursement rates and address underpayments, ensuring your practice is fully compensated for all rendered services. -
Personalized Billing Approach
PGM provides customized billing solutions that align with the specific needs of gastroenterology practices, including handling bundled procedures, high-volume diagnostics, and Medicare requirements. -
Expert-Level Compliance Oversight
Our team stays fully up to date with CMS guidelines and commercial payer rules, ensuring your billing is always accurate, compliant, and audit-ready. -
Proactive Denial Prevention
We analyze trends, monitor claims, and resolve issues early to prevent denials — helping reduce rework and accelerate reimbursement. -
End-to-End Revenue Cycle Management
Beyond billing, we manage your entire gastroenterology revenue cycle, including eligibility checks, charge entry, payment reconciliation, and performance tracking. -
Data-Driven Practice Analytics
Our reporting platform provides clear, actionable insights into your financial performance, enabling smarter decisions that drive revenue and operational improvements.
PGM Revenue Cycle Management
Gastroenterology Billing Software Solutions
PGM leverages advanced GI billing software to automate critical billing tasks, minimize claim errors, and accelerate reimbursement cycles. Our technology is designed to help gastroenterology practices manage patient data more effectively, track claims in real time, and navigate complex payer requirements with confidence.
Proof in Numbers
With our deep experience in gastroenterology billing outsourcing, we enable practices to improve efficiency, boost reimbursement rates, and reduce administrative workload. By partnering with PGM, your team can stay focused on delivering high-quality GI care while we manage the complexities of your gastroenterology revenue cycle behind the scenes.
Why Choose PGM for Gastroenterology Billing Outsourcing?
Effective gastroenterology billing demands precision, specialized expertise, and a thorough understanding of the specialty’s shifting financial and regulatory environment. At PGM, we provide expert GI billing services that streamline revenue cycle management, reduce administrative workload, and maximize reimbursement. As a leading GI medical billing company, we offer complete, customized solutions that ensure accuracy, compliance, and long-term financial success.
Proven Expertise in Gastroenterology Billing
With decades of experience in gastroenterology billing outsourcing, PGM understands the unique challenges faced by GI practices. From advanced diagnostic coding to complex therapeutic procedures and bundled service billing, we ensure every claim is submitted accurately and on time. Our expertise includes billing for:
- Diagnostic and therapeutic colonoscopies (CPT codes 45378–45385)
- Upper GI endoscopies with biopsy or dilation (CPT 43235–43239)
- Endoscopic polypectomy and lesion removal
- Capsule endoscopy (CPT 91110) and GI motility studies
- Colorectal cancer screenings and surveillance procedures
- Hemorrhoid ligation and other in-office procedures
Certified Billing Professionals
Our team includes certified medical billing experts who specialize in gastroenterology coding and billing. We stay up to date with CPT, ICD-10, and HCPCS changes to ensure compliance with Medicare, Medicaid, and commercial payers. Our professionals work to minimize denials and maximize revenue through precise coding and documentation.
Custom Solutions for Gastroenterology Billing
PGM delivers tailored solutions that align with your practice’s specific workflow and billing needs. Our advanced GI billing software integrates seamlessly with your EMR system and supports:
- Automated charge capture to reduce errors and missed billing opportunities
- Custom financial dashboards for real-time revenue tracking
- Integrated eligibility verification to reduce upfront denials
- Secure, HIPAA-compliant electronic claims submission for faster payments
Maximized Reimbursement for Gastroenterology Practices
Our services are built around driving financial performance. PGM ensures:
- Accurate coding for bundled and standalone GI procedures
- Complete documentation to support medical necessity
- Management of appeals for denied or underpaid claims
- Payer negotiation to improve contract rates and reimbursement levels
With PGM’s gastroenterology billing outsourcing, your practice gains improved collections, reduced operational stress, and more time to focus on what matters most — patient care.
Exceptional Customer Service for Gastroenterology Billing
Managing billing for gastroenterology requires precision, experience, and a deep understanding of the specialty’s financial complexities due to the complexity of diagnostic procedures, therapeutic treatments, and stringent payer requirements. At PGM, we offer expert GI billing services that simplify revenue cycle management, reduce administrative strain, and improve reimbursement outcomes. As a leading GI medical billing company, we deliver comprehensive, high-performance solutions built for financial accuracy, regulatory compliance, and long-term success.
Dedicated, Personalized Support
PGM provides personalized service, not one-size-fits-all solutions. Our dedicated account managers work closely with your practice, offering responsive communication, proactive updates, and reliable support. Whether you’re dealing with claim submissions, reimbursement disputes, or coding updates, our gastroenterology billing experts are always available to assist your team.
Expertise in Gastroenterology Billing and Coding
Our team is deeply experienced in the unique challenges of gastroenterology coding and billing. We stay current on CPT code updates, ICD-10 changes, and evolving payer policies to ensure every claim is accurate, compliant, and optimized for reimbursement. From diagnostic and therapeutic colonoscopies to endoscopic procedures and capsule endoscopy, PGM handles every aspect of GI billing with precision.
Efficient Claims Processing and Denial Management
PGM’s advanced technology and rigorous review process help minimize claim errors and denials. We carefully audit all claims before submission to ensure coding accuracy and complete documentation. In the event of a denial, our team acts quickly to resolve the issue and resubmit the claim for payment.
Compliance and Regulatory Guidance
Billing for gastroenterology services requires strict adherence to CMS guidelines, commercial payer rules, and ever-changing regulatory standards. PGM offers ongoing compliance oversight to help your practice avoid audits, recoupments, and penalties. We ensure your GI billing services stay fully aligned with Medicare, Medicaid, and private insurance policies.
Enhancing Your Practice’s Financial Health
PGM doesn’t just manage claims — we help strengthen your financial foundation. Through transparent reporting, revenue cycle analysis, and actionable performance insights, we empower your practice to improve profitability and focus more fully on delivering quality GI care.
With PGM as your billing partner, your gastroenterology practice benefits from expert support, efficient claim workflows, and a customer-first approach built for lasting success.
Learn More About Our Leading Gastroenterology Medical Billing Company
Ready to optimize your gastroenterology billing process? PGM offers a complimentary consultation and demo to show how our customized GI billing services can streamline your revenue cycle, reduce denials, and ensure maximum reimbursement for every procedure you perform.