Gastroenterology Coding Alert

Don’t use codes 0240T and 0241T for CY 2016.

As a gastroenterology practice, you may be encountering esophageal manometry cases more frequently as physicians have started using it as a standard procedure prior to surgery for gastroesophageal reflux disease (GERD). With an estimated 19 million Americans suffering from GERD and a public education program being launched by the American College of Gastroenterology to increase awareness of the disease, these tips will help you avoid problems concerning how to properly code for interpreting your patients’ manometry results.

Tip 1: Understand the Procedure and Necessity for Manometry

Esophageal manometry or motility study is one of the main tests performed for definite diagnosing GERD. Usually, attending GIs can recognize GERD from common symptoms but complicated cases may need additional tests to be definitively diagnosed. The major use of esophageal manometry is to measure pressure within the esophagus to assist in the diagnosis of esophageal pathology including aperistalsis, spasm, achalasia, esophagitis, esophageal ulcer, esophageal congenital webs, diverticuli, scleroderma, hiatus hernia, congenital cysts, benign and malignant tumors, hypermotility, hypomotility, and extrinsic lesions. Esophageal manometry is mostly used in difficult diagnostic cases and as an adjunct to X- rays and direct visualization of the esophagus (endoscopy) through the fiberscope.

Familiarity with the procedures performed is the cornerstone for the accurate reporting. Esophageal manometry is a test used to evaluate neuromuscular disorders of the esophagus. This procedure also is used to evaluate unexplained swallowing problems or chest pains. On the other hand, endoscopy looks at disorders of the mucosal lining, such as cancers and ulcers, he says.

During the procedure, a small catheter with water flow pressure transducers is placed into the esophagus through either the patient’s nose or throat and inserted into the stomach. The catheter is then withdrawn a half-inch at a time while a pressure profile of the lower esophageal sphincter is recorded at each point. In addition, the patient is asked to swallow a teaspoon of water at least 10 times during the procedure to measure the other muscular functions of the esophagus. The GI may sometimes administer a stimulating agent to aid in motility testing. He may also order acid perfusion studies along with manometry.

For the basic test you should use CPT^® code 91010 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study with interpretation and report) and +91013 (... with stimulation or perfusion …) if a stimulant was given or perfusion was performed. The acid perfusion (Bernstein) test is used to confirm whether the symptom of chest pain has been really caused due to GERD. 

Heads up: Do not use earlier codes 0240T (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study with interpretation and report; with high resolution esophageal pressure topography) or 0241T (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study with interpretation and report; with stimulation or perfusion during high resolution esophageal pressure topography study [e.g., stimulant, acid or alkali perfusion] [List separately in addition to code for primary procedure]) as CPT^® 2016 code set has deleted both the codes.

Tip 2: Remember the Two Components to Reimbursement

Esophageal manometry includes both a technical and a professional component. The technical component represents the value assigned to the ownership and maintenance of the equipment and the use of any technicians. For a gastroenterologist to bill for the technical component of any diagnostic service, he or she must own (or partially own by being a partner in a practice) the equipment being used. If the manometry is done in a hospital setting, then the hospital may bill for the technical component of the test.

The professional component represents the physician’s interpretation of the test results. When the gastroenterologist only does the interpretation of the manometry results, he or she may bill for reimbursement for the professional component using code 91010 with modifier 26 (Professional component).

Criteria to qualify as an interpretation: For the test result readings to qualify as interpretations, the findings must be written in a separate report that is kept in the patient’s medical record. The gastroenterologist also should indicate that this is his or her interpretation of the test by signing the test.

If the gastroenterologist both owns the manometry equipment and interprets the test results, he or she bill for reimbursement of both the technical and professional components using code 91010 without any modifier. This code can be used regardless of whether the gastroenterologist, a nurse or a technician actually performs the manometry.

Tip 3: Don’t Forget Medical History

When GERD patients present in your physician’s office with heartburn, chest pain or similar symptoms, the GI will first attempt to take the patient’s history and detailed symptoms. He will perform a problem-focused history and examination with straightforward decision making. Many times, the physician may be sufficiently satisfied with the symptoms for a confirmed diagnosis and start the patient on GERD medication to relieve the symptoms. Don’t miss this coding opportunity by watching out for the most common symptoms such as:

• R12 (Heartburn)
• R05 (Cough)
• K20.- (Esophagitis) or K21.0 (Gastro-esophageal reflux disease with esophagitis)
• K30 (Functional dyspepsia)
• R06.2 (Wheezing)
• J37.0 (Chronic laryngitis)
• J37.1 (Chronic laryngotracheitis)
• J04.0 (Acute laryngitis).

Link these codes to appropriate E/M codes 99202-99205 for reporting the encounter. The code for confirmed GERD is K21.9 (Gastro-esophageal reflux disease without esophagitis).