NEW YORK, NY — August 29, 2026 — Transcure today published a descriptive analysis of first-submission claim denials recorded from January through June 2026 across 340 gastroenterology practices in its own operational dataset.
The review examined coding accuracy, prior authorization completion, payer-specific denial categories, screening-to-diagnostic conversion handling and same-day procedure bundling. Participating practices included single-provider offices and multi-site groups with varying ownership structures, payer mixes and procedure volumes.
Reported Denial Categories
Among denials included in the category analysis, Transcure reported:
- 27% involved screening-to-diagnostic conversion errors, with codes such as G0121, 45378 and 45385 appearing in the reviewed records.
- 22% involved missing or incorrect prior authorization, including records associated with codes 43239, 43242 and capsule endoscopy procedures.
- 19% involved NCCI bundling conflicts for same-day procedures, frequently associated with codes 43235, 45378 and 45380.
- 16% involved unspecified ICD-10 diagnosis codes, including K57.30 and K21.9.
- 11% involved documentation that did not establish medical necessity, including records associated with codes 45380 and 43239.
These categories account for 95% of the denials described in the analysis. This release does not characterize the remaining 5%.
The review identified recurring administrative issues, including omitted modifier 33 reporting on converted screening claims, unaddressed NCCI edits when colonoscopy and upper endoscopy procedures shared a date of service, and diagnosis-code selection that was less specific than the supporting documentation.
“The findings indicate that practices should examine claim edits at the point where screening status changes, authorization requirements are confirmed and same-day procedure combinations are prepared,” said Transcure’s revenue-cycle research team. “These are practical workflow checkpoints for coding and billing personnel, but the results should be interpreted within the limits of this dataset.”
Methodology and Limitations
The analysis used claims records available in Transcure’s own dataset for 340 gastroenterology practices between January 1 and June 30, 2026. For this report, a denial means a first-submission claim denial recorded in the source data. Results are descriptive and do not establish causation.
Important limitations include:
- The total number of claims reviewed was not reported in the analysis summary.
- Practice-level and ownership-model subgroup sizes were not reported.
- Geographic distribution and practice-selection criteria were not provided.
- The summary did not document a formal data-cleaning protocol.
- No prior comparison period was included; therefore, this release does not make year-over-year or cycle-over-cycle trend claims.
- No confidence intervals, significance tests or other inferential statistical measures were reported.
- The results may not represent gastroenterology practices outside Transcure’s dataset.
- No independent review of the analysis is reported.
- The dataset is proprietary to Transcure, and this release does not provide a breakdown identifying the sampled practices as clients, nonclients or prospective clients.
Transcure has a commercial interest in revenue-cycle services. The term Gastroenterology Billing Services refers here to a service category that may include GI-focused coding review, claim editing and prior authorization tracking. The descriptive findings do not constitute an independent assessment of Transcure’s services or establish that outsourcing these functions changes denial rates.
About Transcure
Transcure is a revenue-cycle research and services organization focused on specialty medical-practice billing performance. Its research team analyzes claims-level data to identify operational and coding factors associated with denials and develops reporting for practice managers and billing professionals.
For media inquiries, contact Media Relations at contact@transcure.net or visit Transcure.