Gastroenterology Coding Alert

Catch pairing with anesthesia and injection services too.

When your gastroenterologist performs a gastrointestinal transit and pressure measurement (91112, Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report) using a wireless capsule, you cannot report any other motility studies or a capsule endoscopy procedure that is performed concurrently. The latest round of Correct Coding Initiative edits (19.0) include a host a codes that you cannot report when you are reporting 91112:

91020 — Gastric motility [manometric] studies

91022 — Duodenal motility [manometric] study

91111 — Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus with interpretation and report

91117 — Colon motility [manometric] study, minimum 6 hours continuous recording [including provocation tests, e.g., meal, intracolonic balloon distension, pharmacologic agents, if performed], with interpretation and report

Reminder: The above mentioned code bundles carry the modifier indicator ‘0,’ indicating that you cannot report 91112 with any of these codes under any circumstances. If you do, only the 91112 services will be paid and reimbursement for the other service will be denied.

Rationale: "The commercial device used to perform gastrointestinal transit and pressure measurement is known as the SmartPill," says Michael Weinstein, MD, Gastroenterologist at Capital Digestive Care in Washington, D.C., and former representative of the AMA’s CPT^® Advisory Panel. "Prior to the approval of the Class I code, 91112, this service was reported using a Class III New Technology code, 0242T. The SmartPill is useful in diagnosing gastroparesis (536.3, Gastroparesis), unspecified constipation (564.00, Unspecified constipation) and: slow transit constipation (564.01, Slow transit constipation)."

Don’t Report Moderate Sedation Services Separately

You cannot report moderate sedation when administered in the same session during which your gastroenterologist performs gastrointestinal transit and pressure measurement, according to CCI 19. 0. So, you cannot report the following codes with 91112:

99148 -- Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; younger than 5 years of age, first 30 minutes intra-service time

99149 -- age 5 years or older, first 30 minutes intra-service time

+99150 -- each additional 15 minutes intra-service time [List separately in addition to code for primary service]

Avoid Reporting Therapeutic or Diagnostic Injections with 91112

When your gastroenterologist performs gastrointestinal transit and pressure measurement, you cannot report any injection procedures that are performed in the same session, according to CCI edits 19.0. So you will not report any of the below mentioned codes along with 91112 when these procedures are performed in the same session:

62310 -- Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic

62311 -- …lumbar or sacral [caudal]

62318 -- Injection[s], including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic

62319 -- …lumbar or sacral [caudal]

64490 -- Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single level

+64493 -- …second level [List separately in addition to code for primary procedure]

96372 -- Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular

96374 -- …intravenous push, single or initial substance/drug

+96375 -- each additional sequential intravenous push of a new substance/drug [List separately in addition to code for primary procedure]

+96376 -- each additional sequential intravenous push of the same substance/drug provided in a facility [List separately in addition to code for primary procedure]

Note: While the CCI bundling of 91112 with 62310, 62318, 64490 and 96372 carry the modifier indicator ‘0’ the other above mentioned codes carries the modifier indicator ‘1’ that denotes that you can break the code bundle by using an appropriate modifier (such as modifier 59, Distinct procedural service) to these codes. For more details, check the CCI edits checker at https://www.aapc.com/codes/.