Gastroenterology Coding Alert

Report all studies lasting more than an hour with 91038

Although you should no longer consider time a factor when reporting esophageal motility (for example, 91010, Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study), time is still an important factor for esophageal function tests.

Consider these two quick tips to aid your coding of these important procedures.

Tip 1: Back Away From the Unlisted-Procedure Codes

Prior to 2005, you would have had to use an unlisted-procedure code to report esophageal function tests. With the introduction of CPT 2005, however, gastro-enterology practices gained two specific codes to describe these procedures, said Joel V. Brill, MD, chief medical officer of Predictive Health LLC in Phoenix, in a recent Coding Institute teleconference, -The Future of Gastroenterology: How to Prosper Despite Coming Changes-:

- 91037--Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation

- 91038--... prolonged (greater than 1 hour, up to 24 hours).

How to identify the test: Prolonged gastroesophageal reflux impedance testing monitors all reflux (both acid and non-acid), says Michael Weinstein, MD, a gastro-enterologist in Washington, D.C., and a former member of the CPT advisory panel. The GI physician inserts a bolus transit impedance catheter transnasally. The test measures both muscular function and bolus transit dynamics (this differentiates esophageal function testing from esophageal motility--which measure only muscular activity--as described by 91010).

In short: Although both motility study and function (impedance) testing use a nasal catheter, the esophageal impedance probe is -more sensitive- and measures more things than the motility test covered by 91010.

Tip 2: Document Time

As instructed in the descriptors of 91037-91038, you should apply these codes according to how long the monitoring lasts. You should apply 91037 for testing that lasts up to one hour. For testing of one hour or more, you should reach instead for 91038.

Don't overcode: You should not apply 91037 and 91038 for the same test. In other words, you shouldn't report 91037 for the first hour and 91038 for additional time. Instead, you should apply only a single code to report the session.

For example: The gastroenterologist inserts the nasal catheter to record esophageal impedance and muscle function for a patient who complains of frequent and painful heartburn. The GI doctor leaves the monitor in place until the next day, about 24 hours later. In this case, you should report one unit of 91038, Weinstein says.

Learn more: For complete information on esophageal motility and pH testing, see -Learn Your GERD Testing Options in 5 Easy Steps- on page 9 of the February 2006 Gastroenterology Coding Alert.