2026 billing guide · GI
Gastroenterology, coded right.
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.
Workhorse code
99214
1.92 wRVU each
Top codes covered
10
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 99214 is the workhorse of primary care and most outpatient subspecialties. Use it when at least one of these is true: two or more chronic problems with progression, treatment changes, or side effects; one undiagnosed new problem with uncertain prognosis; one acute illness with systemic symptoms; or prescription drug management at any complexity. Prescription drug management on its own satisfies the moderate-risk element, which is why straightforward chronic disease follow-ups with a med adjustment routinely clear the 99214 bar. Time-based alternative is 30 to 39 minutes of total time on the date of the encounter. Pick the method that supports the strongest note: encounters with prescription changes are usually cleaner under MDM; encounters with extensive counseling or care coordination are usually cleaner under time. | 1.92 | 4.06 | $136 | Details → |
| 99215 | Office o/p est hi 40 min Use 99215 when the encounter genuinely required high-complexity decision-making: severe exacerbation or decompensation of a chronic illness, an acute or chronic illness or injury that poses a threat to life or bodily function, decision regarding hospitalization, drug therapy requiring intensive monitoring for toxicity, or extensive comorbidity management driving a high-risk decision. Real examples: a CHF patient with new bilateral leg edema and dyspnea where you considered emergency admission; a new-onset AFib with RVR you elected to manage outpatient with same-day rate-control titration; an oncology patient with febrile neutropenia. Time-based alternative is 40 to 54 minutes of total time on the date of the encounter. | 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 → |
Pro feature
Unlock the full GI coding guide
Scenarios that show how the codes stack on real encounters, payer-specific modifier rules, and bundling pitfalls for GI are part of the Pro tier. Infectious Disease stays free as a sample.
- ✓Every other specialty in the catalog unlocks
- ✓30 chart audits per day on top of this
- ✓Full Comp Database with p10 / p90 granular percentiles
Need a code outside this list?
Search the full library or jump straight to the calculator to model volumes.
Educational reference, not billing or legal advice. Coverage curated, not exhaustive. Verify against payer contracts.