Endoscopy and colonoscopy on the same day: are two fees paid?

“If the endoscopy and colonoscopy are performed on the same day, do I pay two equipment fees?”

Rivio answers:

Charging equipment fees when an upper gastrointestinal endoscopy (EGD) and a colonoscopy are performed on the same day is a frequent question in outpatient and hospital billing. The answer depends on the contract signed with the payer, the reference table used and the specific billing rules set by the health plan.

There is no single rule that applies to every case, but three scenarios are common.

1. Two fees charged separately

When the contract allows individual charges, two equipment fees can be posted, one for each test. This is because endoscopy and colonoscopy are distinct procedures, with their own codes and different technical times, even when performed on the same date.

2. A single combined fee

Some payers take the view that the tests share the same infrastructure, room and equipment, and authorize only one equipment fee for both procedures. This position is usually spelled out explicitly in the contract or in the health plan’s operating guidelines.

3. The second fee charged at a reduced value

There are also payers that authorize both fees, but with a percentage reduction on the second one, such as 100% of the first fee and 50% of the second. This middle-ground rule seeks to balance the shared use of the infrastructure with the recognition of two distinct technical acts.

Check the contract to avoid denials

Whatever the scenario, it is essential to consult the contract and the payer’s specific rules before billing. A lack of alignment can result in automatic denials, rework for the team and financial loss for the institution.

Correct contract interpretation and proper recording of procedures are decisive for ensuring compliance, revenue predictability and security in the billing cycle.