GI
Gastroenterology
Procedure-heavy. Most outpatient GI revenue comes from upper and lower endoscopy with modifier-driven add-ons (biopsy, polypectomy, dilation). Screening vs diagnostic coding has different patient cost shares and modifier rules.
Top billed codes
The codes that drive revenue in this specialty. Click any code for documentation requirements, modifiers, and pitfalls.
| Code | Description | wRVU | Total RVU | Medicare $ | |
|---|---|---|---|---|---|
| 99214 | Office o/p est mod 30 min The workhorse code. Two or more chronic problems with progression/treatment changes, OR one undiagnosed new problem with uncertain prognosis, OR prescription drug management. | 1.92 | 4.06 | $136 | Details → |
| 99215 | Office o/p est hi 40 min Severe exacerbation, decompensated chronic illness, decision regarding hospitalization, or extensive comorbidity management requiring high-risk decision-making. | 2.80 | 5.76 | $192 | Details → |
| 45378 | Diagnostic colonoscopy Diagnostic colonoscopy (symptoms, surveillance) without biopsy or therapeutic intervention. | 3.36 | 8.62 | $288 | Details → |
| 45380 | Colonoscopy w/ biopsy Diagnostic colonoscopy with biopsy (no polypectomy by snare). | 3.91 | 9.79 | $327 | Details → |
| 45385 | Colonoscopy w/ snare polypectomy Diagnostic colonoscopy with snare polypectomy. | 4.43 | 10.90 | $364 | Details → |
| 45381 | Colonoscopy with submucosal injection Submucosal injection (e.g. saline lift before resection, India ink tattoo). | 4.42 | 9.80 | $327 | Details → |
| 43235 | Diagnostic EGD Diagnostic EGD without biopsy or intervention. | 2.06 | 5.30 | $177 | Details → |
| 43239 | EGD w/ biopsy EGD with biopsy of one or more sites. | 2.39 | 5.94 | $198 | Details → |
| 43249 | EGD with balloon dilation EGD with balloon dilation of esophagus or stomach. | 3.16 | 7.39 | $247 | Details → |
| 91065 | Breath test H pylori Office breath test, typically for H. pylori urea breath test or SIBO eval. | 0.00 | 1.33 | $44 | Details → |
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Educational reference, not billing or legal advice. Coverage curated, not exhaustive. Verify against payer contracts.