Gastroenterology Coding Alert

Refresh your knowledge of 91200, 91065, 91110, 91010, and 91122.

You don’t have to memorize every obscure code or know the exceptions to every rule off the top of your head to be a great coder. Sometimes, the best way to improve your coding skills is to ensure that you know how to use the most common codes — the ones you are most likely to use on a regular, if not daily, basis — without hesitation or confusion.

Five of the most common gastroenterology CPT^® codes are:

• 91200 (Liver elastography, mechanically induced shear wave (eg, vibration), without imaging, with interpretation and report)
• 91065 (Breath hydrogen or methane test (eg, for detection of lactase deficiency, fructose intolerance, bacterial overgrowth, or oro-cecal gastrointestinal transit))
• 91110 (Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and report)
• 91010 (Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report)
• 91122 (Anorectal manometry)

Do you know how to properly use these codes? Brush up on your gastroenterology coding skills by reviewing the following tips.

Familiarize Yourself With 91200

Where is it: Within the Other Procedures subsection of the Gastroenterology codes.

When to use it: For liver elastography procedures. This procedure distinguishes normal tissue from lesions in the liver and determines whether the lesion(s) are benign or malignant.

What to watch out for: Use modifier 52 (Reduced services) or modifier 53 (Discontinued procedure) if appropriate, depending on the course of the liver elastography. Keep in mind that there are several other modifiers that can apply to 91200 — more on that later.

Breathe New Life Into Your 91065 Knowledge

Where is it: Under the Gastroenterology code section.

When to use it: When the provider performs a breath hydrogen or methane test to evaluate the patient for lactose intolerance, fructose intolerance, bacterial overgrowth, or oro-cecal transit time.

What to watch out for: Know the differences between 82542 (Column chromatography, includes mass spectrometry, if performed (eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen), which is also used in hydrogen breath testing, and 91065. Use code 82542 when a clinician performs column chromatography or mass spectrometry to evaluate for the presence or amount of a nondrug analyte.

View These Tips for 91110

Where is it: Under the Gastroenterology code section.

When to use it: When a provider performs a capsule endoscopy ranging from the esophagus to the ileum.

What to watch out for: Use 91111 (Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus with interpretation and report) instead of 91110 if the capsule endoscopy does not include the small bowel. Also, remember to list the date of service as the date of ingestion — the number of days that the patient was connected to the device is irrelevant.

Learn How to Report 91010

Where is it: Under the Gastroenterology code section.

When to use it: Assign 91010 when a gastroenterologist assesses the esophageal muscle pressure and movement of a patient diagnosed with gastroesophageal reflux disease (GERD).

What to watch out for: Several modifiers can apply to 91010; see more on modifiers below.

Understand When to Report 91122

Where is it: Under the Gastroenterology code section.

When to use it: Assign 91122 when a provider measures the contraction of the rectum and anal sphincter.

What to watch out for: Modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) or 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period) may apply if a patient needs to return to the operating room during the postoperative period.

Append modifier 78 to 91122 when a patient has a related surgical procedure during the initial procedure’s postoperative period. Use modifier 79 with 91122 when a patient has an operation unrelated to the initial procedure during the initial procedure’s postoperative period. Find more information about modifiers that may apply to 91122 below.

Get to Know the Common Modifiers in Gastroenterology

The CPT^® code set features six modifiers that frequently pair with the top five gastroenterology codes. Essentially, these six modifiers have two functions: distinguishing whether billing is for the professional or technical component of a service or clarifying the purpose of repeat services.

Use modifier 26 (Professional component) when billing only for the professional component, not the technical component, of a service. Conversely, use modifier TC (Technical component …) to bill only for the technical component of a service.

The following four modifiers clarify the purpose of repeat services:

• Modifier 59: Use this modifier to distinguish a service from other, separate services performed on the same day. Only use modifier 59 (Distinct procedural service) if no other modifier is appropriate; do not use modifier 59 for evaluation and management (E/M) service codes. If you need to report a separate E/M service performed on the same day as a non-E/M service, use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) instead.
• Modifier 76: This modifier helps indicate that a repeat service was intentional and is not a duplicate billing. Use modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) if a patient receives a repeat procedure by the same provider on the same day.
• Modifier 77: Similar to modifier 76, use modifier 77 (Repeat procedure by another physician or other qualified health care professional) for repeat procedures on the same day. The key difference between modifier 76 and modifier 77 is that modifier 77 is reserved for when a different provider performs the same procedure on the same patient on the same day.
• Modifier 91: Use this modifier to indicate that there was a clinical reason for repeat testing. Modifier 91 (Repeat clinical diagnostic laboratory test) is only appropriate to use for repeat laboratory services on the same day by the same provider; if the services are distinct, use modifier 59 instead.

Michelle Falci, BA, M Falci Communications LLC