A colonoscopy that starts as screening can end with a polyp removed, and the claim has to show both. Miss a modifier and the patient may get a bill they should not owe. Hepatology adds years of chronic liver follow-up and specialty drug paperwork.
Book a demoMost rework in a GI practice traces back to procedure intent, follow-on screening, or long-running liver care.
Medicare uses G0105 or G0121 for screening colonoscopy and modifier PT when a screening case converts to biopsy or polyp removal. Commercial and Medicaid plans generally expect modifier 33 on the procedure code. A missing modifier can shift cost sharing onto the patient.
Since 2023, Medicare treats a colonoscopy after a positive stool-based screening test as part of complete screening, without patient cost sharing. The claim needs the KX modifier, or the contractor returns it or processes it under the older rules.
Patients with fatty liver disease, hepatitis, or cirrhosis return for years, with imaging, labs, and specialty medications along the way. Prior authorizations and pharmacy work often sit outside the claim, so name who owns them today.
An endoscopy day can produce a professional claim, a facility claim, an anesthesia claim, and a pathology claim. Only some of them are yours.
Your physicians document procedure intent, findings, and pathology follow-up, and sign off on codes before submission. Screening versus diagnostic intent starts in the note, so it stays with the clinician.
If the fit is confirmed, Taiga would draft codes from procedure and clinic notes, scrub claims for payer modifier rules, check eligibility, and work every denial and appeal to resolution.
Scopes done at an ambulatory surgery center or hospital bring related claims from other billers. Decide who answers the patient who calls about all of them at once.
Bring de-identified procedure notes and a few denial examples. Keep patient details out of the booking form.
List office, ASC, and hospital endoscopy locations, and whether the group has an ownership stake in any facility.
Share how often screening cases convert, your Medicare, Medicaid, and commercial mix, and where cost-sharing complaints come from.
Describe hepatology follow-up, who handles prior authorization for specialty medications, and how pathology and imaging results reach the chart.
Useful for a gastroenterology or hepatology group that bills its own professional claims and wants a direct answer on whether Taiga can carry its procedure and clinic volume. No EHR change is involved.
This page does not cover ASC facility billing, anesthesia billing, or pathology claims. Each has its own submitter, so name them on the call before any work moves.
It is not one of the specialties Taiga names publicly. Bring your procedure and clinic mix to a call and you will get a direct answer on fit.
On Medicare claims, a screening colonoscopy that becomes a polypectomy needs modifier PT on the procedure code, and commercial plans generally use modifier 33. Without it, the payer may treat the case as diagnostic and apply cost sharing.
Medicare counts that follow-on colonoscopy as part of complete screening when the KX modifier is on the claim. Without KX, the claim may be returned or processed under older rules.
Clinic visits use the same evaluation and management codes. The extra work in hepatology is tracking long-term follow-up and specialty drug authorizations.
Share your procedure locations, screening volume, and liver clinic setup. Taiga will tell you which parts it can take on and which should stay where they are.
System guides show possible billing handoffs, not proven specialty compatibility.