Gastroenterology Coding Alert

Find out if you need a modifier when reporting these codes together

Capture these expert ins and outs of reporting motility studies and standard pH tests gastroenterologists use to diagnose GERD, and your claims will be picture-perfect.

Master These Motility Study Codes

If a patient reports to your office with symptoms that could indicate GERD but doesn't have typical endoscopy findings or improvement with acid-suppression medication, the gastroenterologist may try other testing methods to determine the patient's condition, experts say.

If the physician refers to an esophageal -motility study,- you should choose from among three codes:

- 91010 -- Esophageal motility (manometric study of the esophagus and/or  gastroesophageal junction) study

- 91011 -- - with mecholyl or similar stimulant

- 91012 -- - with acid perfusion studies.

-The highest code volume in one of our practices is 91010,- says Diana Wilson, CPC, coding and reimbursement manager for Med-Phy Management in San Antonio. Code 91011 describes the basic test plus administration of a stimulant (to increase motility), and 91012 indicates an acid perfusion study in addition to the motility study.

What happens: The physician uses esophageal manometry to evaluate neuromuscular disorders of the esophagus. She passes a thin tube, known as a manometry catheter, through the nose into the esophagus. The manometry   catheter connects to a computer, which records the pressure waves of the esophagus during swallowing.

-This monitors the stomach and small intestine. The provider administers a test meal and/or medication to determine the effects on the upper gastrointestinal tract,- says Edwin Elson, CPC, practice manager for Pediatric Gastroenterology and Nutrition of Tampa Bay in Florida. If you see notations in the physician's notes describing these pressure readings, you know you-ve got a manometry procedure.

Stick With 91034 for Standard pH Test

When your gastroenterologist provides an esophageal acid reflux test using either a disposable or a reusable nasal catheter, you should report 91034 (Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode[s] placement, recording, analysis and interpretation). -What happens with 91034 is the provider applies tape to the tubing, and the analysis is a result of the information that was collected throughout a period of time,- Wilson says.

Example 1: A patient reports for a pH study to identify the cause of acute esophagitis. The gastroenterologist performs a seven-hour pH monitoring session.  

On the claim, you should:

- report 91034 for the pH testing.

- attach 530.12 (Acute esophagitis) to 91034 to   represent the patient's symptoms.

- document any previous treatments or tests the gastroenterologist performed on the patient for the condition.

In most cases, the physician will leave the catheter in place for 18-24 hours, Elson says. But you will claim 91034 (without a -reduced service- or -unusual service- modifier) regardless of how long the catheter remains in place. This differs from past practice, in which you had to distinguish between standard and -extended- pH monitoring.

Example 2: For pH testing lasting six hours using a nasal catheter, you would report 91034. If the physician leaves the catheter in place for 26 hours, however, the coding would be the same.

Heads up: If your gastroenterologist conducts pH testing using a Bravo capsule, you will turn to 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation) instead of 91034. The Bravo capsule has advantages over a standard catheter pH study,  including greater patient comfort and the ability to monitor pH levels over a longer time period.

Both Tests in Same Session Possible

If your GI physician performs manometry and pH study for the same patient, you may report the procedures separately and expect separate reimbursement, even if the tests occur on the same date of service. -I do not think there should be a problem billing the two codes because they are different tests,- Wilson says. You shouldn't need to report any modifiers to separate the services.

Another way: As an alternative to billing manometry and pH study on the same day, you may report the manometry on the first day and use the date of service for the pH study as the day the test is completed (in other words, you will place the probe for the pH study on the same day as the manometry, but you will report the pH study on the next day of service, after the 24-hour monitoring has concluded).

Example: The physician meets with the patient on Tuesday, performs manometry and places the probe for 24-hour pH study. For Tuesday's visit, you would report 91010, along with any significant, separately identifiable E/M service.

The patient returns on Wednesday to complete the pH study. On this date, you would report 91034 or 91035, depending on the method. In this case, you would probably not report a separate E/M service because the patient returned for a planned service, not a new complaint/exacerbation that requires a revised history, exam and medical decision-making.

Rule of thumb: Report 91010 on the date of service and 91034 the next day -- or whenever the gastroenterologist removes the probe.

Observe Modifier 26, TC Exceptions

When reporting either 91010 or 91034, you must remember that carriers will not pay you for the entire code unless your office owns the equipment. If your gastroenterologist is using another facility's equipment to perform the manometry, you should attach modifier 26 (Professional component) to the CPT code, Wilson says.

Example: Your practice has its own equipment set up in the office. When your GI physician performs esophageal manometries or pH studies in your office, you should report these encounters without any modifiers. 

On the other hand, when your physicians treat Medicare and Medicaid patients at local hospitals, you should report the encounters with modifier 26 attached to indicate that your practice only deserves payment for the professional service. In those instances, the hospital will report the appropriate APC code for Medicare or Medicaid patients or use the CPT code with modifier TC (Technical component) for the technical component only.