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 [...]