Gastroenterology Coding Alert

Sometimes, a reflux test is only half the claim

When your gastro administers a reflux test and inserts a Bravo capsule during the same session or checks for reflux and performs an esophageal manometry, you should not report either of these procedures the same way you did in 2004.

To be compliant when reporting these test combinations in 2005, you'll have to learn a few new tricks (and forget some old ones). We'll examine each of these multiple-procedure scenarios and get some expert advice on how to make your reflux claim reflect rock-solid medical care. New Code Reflects Bravo Cap/Reflux Combo If the gastroesophageal reflux test includes a Bravo capsule insertion during the same session, you should now use CPT 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation).

When would the doctor do this? There are several occasions when a physician might opt to perform a Bravo insertion and a reflux test during the same session, says Cheryl Pistone, director of clinical services at Consultants in Gastroenterology in Independence, Mo.

Some physicians insert the Bravo cap over a standard pH probe "because you can insert the capsule so it can't be seen outside the body, so patients can go about their normal days. Also, you can get 48 hours of information as opposed to only 24 hours, as would be the case with the standard pH probe," Pistone says. Yes, You Can Still Report Pre-Bravo EGD When a gastroenterologist inserts a Bravo capsule, he must first perform an upper gastrointestinal endoscopy (EGD) on the patient to "determine how far down to place the Bravo cap," says Kimberly Green, CPC, project coordinator at University of Pittsburgh Physicians. Sometimes, the EGD is diagnostic; other times, the gastro takes a biopsy, she says.

Example: A patient with a history of reflux esophagitis reports to your office. The gastroenterologist performs an EGD and takes a biopsy, administers the reflux test and inserts a Bravo capsule. On your claim, you should:
   report 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) for the EGD
   report 91035 for the reflux test with Bravo device
   attach 530.11 (Reflux esophagitis) to both 43239 and 91035 to prove medical necessity for the procedures. Service-date alert: When reporting 91035, the date of service should be the date the gastro retrieves the data collection recorder.

Exception: In the above example, if the gastro did not take a biopsy, you would report 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for the EGD instead of 43239. Paperwork Must Back Up 91035 Claim For 91035 claims, most [...]