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Gastroenterology Coding Alert

CPT 2005 Expands to Include New Esophageal Reflux Test Codes

Published on Sat Nov 27, 2004

Yellow cover is just the beginning of changes

Starting in January, gastro coders should think twice before reporting a pair of codes for an esophageal acid reflux test, because CPT 2005 has made the procedure a one-code affair - regardless of the recording time.

The Coding Institute has procured an advanced copy of CPT 2005. The AMA changed the cover color, from 2004's fire-engine red to canary yellow this year, but gastroenterology coders will be more interested in what's inside. CPT 2005 includes several alterations to gastro-specific code groups that you will need to learn before Jan. 1, 2005, when you must begin using the new codes.

When you start using that new calendar in January, gastroenterology practices will see changes in how they code for the following procedures, says Robert B. Cameron, MD, FACG, of the American College of Gastroenterology and the AMA/CPT Advisory Committee:

 

  • esophageal Ph measurement
     
  • esophageal impedance
     
  • rectal and esophageal balloon distention
     
  • breath hydrogen testing
     
  • endoscopic therapy for esophageal reflux.

    Report 1 Code for Reflux Tests

    When a patient reports to your office next year for an esophageal acid reflux test with either a disposable or reusable nasal catheter, you should use 91034 (Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode[s] placement, recording, analysis and interpretation) in all instances.

    To make room for 91034, CPT has deleted two codes:

  • 91032 - Esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux
     
  • 91033 - ... prolonged reading.

    Why? CPT deleted 91032 because it was used to report only a single measurement of pH and was rarely used, Cameron said at November's CPT 2005 Coding Symposium in Chicago.

    Tests With Bravo Probe Get Separate Code

  •  CPT 2005 also offers up 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation) for when your gastroenterologist performs a Bravo probe while conducting a reflux test. 

    When should I use it? Consider this example from the AMA's CPT Changes: An Insider's View 2005. 

    "A male presents with severe chest pain. A thorough cardiac evaluation suggested no cardiac abnormality. The patient was placed on pharmacological agents, but symptoms have persisted. An upper gastrointestinal endoscopy (EGD) revealed mild, distal esophageal erythema, otherwise unremarkable."

    In this instance, you should report 91035 - after Jan. 1, of course.
     
    Measuring Esophageal Impedance Just Got Easier

  • Get ready to use a pair of codes for coding esophageal impedance studies in 2005, which should make reporting these tests less confusing than before:
     

  • 91037 - Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation
     
  • 91038 - ... prolonged (greater than 1 hour, up to 24 hours).

    "These are new codes for nasal catheter intraluminal impedance measurements of the esophagus. Code 91037 describes an esophageal function test much like the esophageal motility test (91010, Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study)," Cameron said.

    Prolonged Test Has Separate Code

    According to CPT Changes: An Insider's View 2005, a primary-care physician refers a patient to the gastro due to difficulty swallowing and heartburn. The patient has tried pharmacological agents to no avail, so the physician performs a 45-minute nasal catheter impedance test for diagnostic purposes. When this occurs in your office, you should report 91037.

    Exception: In the above example, if the patient's test took two hours, you should report 91038 instead.

    Explanation: "Code 91038 describes a prolonged impedance recording of greater than one hour and up to 24 hours, much like the old 91033 code (Esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux; prolonged recording)," Cameron said.

    Consider Component Modifiers 

     When reporting the latest esophageal pH and impedance test codes, don't forget to consider the setting in which the gastro performed the procedure, experts say.

    "All of the new codes for esophageal pH and impedance testing have a professional component and a technical component," when the gastroenterologist performs the procedure in a hospital outpatient setting, says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel. Weinstein provides the following example to illuminate his point.

    If the gastro performs a Bravo telemetry capsule test on a patient in a hospital outpatient department, the gastro's office would report 91035 for the Bravo test with modifier -26 (Professional component) attached to show that you are only coding for the professional portion of the 91035 code.

    The hospital coding department will also submit a 91035 claim - but with modifier -TC (Technical component) attached instead of modifier -26.

    Question: What if a gastro performs the same procedure at a free-standing facility, such as an independent diagnostic treatment facility?

    Answer: You would code the scenario the same way, Weinstein says.

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