Question: We submitted separate claims for two different patients where one of our gastroenterologists performed capsule endoscopy procedures. The physician performed the procedures on each patient’s esophagus through the ileum and interpreted the results. We billed 91110-26 on one line and 91110-TC on the same line. This claim was denied. We then used 91110-26 and 91110-TC on separate lines, but the claim was denied again. The same issue occurred when we tried to bill 91111 with the same methods.
How can we correct the claims?
Idaho Subscriber
Answer: The reason why your claims are being denied is that your provider is performing both the technical and professional components of 91110 (Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and report), which means you should report both codes without modifiers 26 (Professional component) and TC (Technical component …).
At the same time, 91111 (Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus with interpretation and report) only covers an endoscopy of the esophagus, so this code is incorrect.
The global service includes both imaging and interpretation, so you don’t need to split the professional and technical components on separate lines. You’ll just report 91110 for the procedures.
Mike Shaughnessy, BA, CPC, Development Editor, AAPC
