A new descriptive analysis from revenue cycle company Transcure examined first-submission claim denials across 340 gastroenterology practices from January through June 2026, according to an Aug. 29 news release.
Here are five things to know:
1. Screening-to-diagnostic conversion errors were the leading cause of denials, accounting for 27% of the denials analyzed. These errors commonly involved codes such as G0121, 45378 and 45385, and frequently stemmed from omitted modifier 33 reporting when a screening colonoscopy converted to a diagnostic procedure.
2. Missing or incorrect prior authorization drove nearly a quarter of denials at 22%, with codes associated with upper endoscopy procedures including 43239 and 43242, as well as capsule endoscopy procedures, appearing most frequently in this category.
3. Same-day procedure bundling conflicts accounted for 19% of denials, most often when colonoscopy and upper endoscopy procedures shared a date of service, generating NCCI bundling conflicts involving codes 43235, 45378 and 45380.
4. Unspecified ICD-10 diagnosis codes and documentation gaps made up the remaining major denial categories, at 16% and 11% respectively. Transcure identified diagnosis-code selection that was less specific than the supporting documentation as a recurring issue, along with records where documentation did not establish medical necessity.
5. According to the release, the analysis is descriptive and does not establish causation or represent practices outside Transcure’s own dataset. The total number of claims reviewed was not reported, no prior comparison period was included and Transcure has a commercial interest in revenue cycle services. The results should be interpreted accordingly.
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