Gastroenterology Coding Alert

You'll have to supply evidence of necessity for the scope

If your gastroenterologist performs endoscopy along with acid reflux or gastric motility studies, you may be able to report the endoscopy separately, depending on the circumstances. Consider these three examples:

1. When a patient has severe symptoms, such as difficulty swallowing, the physician will perform the EGD and place the pH monitoring device, such as a Bravo capsule, during the endoscopy.

In this case, you may report the diagnostic endoscopy (for example, 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]) and the pH study 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation).
 
2. The gastroenterologist might experience difficulty inserting a nasal pH catheter because of a hiatal hernia, for instance. Therefore, the physician inserts the probe endoscopically using a guidewire.

Again, you should report both the endoscopy and pH study (in this case, 91034, Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode[s] placement, recording, analysis and interpretation). You should provide documentation of the special circumstances that necessitated the endoscope.

3. The physician may need to perform several procedures on the same day to reach a definitive diagnosis. For instance, the GI performs an EGD and--based on the results--subsequently orders manometry.

In this case, you will report 43235 for the EGD and 91010 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study) for the manometry.

Warning: Most third-party payers will not pay for endoscopies done simply to place the Bravo pH capsule or other pH monitoring device, says Joel Richter, MD, chairman of the department of gastroenterology and hepatology at Cleveland Clinic in Ohio. Documentation should give a compelling reason for using the endoscope.