Gastroenterology Coding Alert

You can report testing and E/M on the same day, with 25

Don't be confused by -acid reflux study- and -gastric motility study.- Although physicians commonly refer to diagnostic tests for gastroesophageal reflux disease (GERD) using these terms, your coding will improve if you think of these tests instead as -pH monitoring- and -gastric- or -esophageal manometry.-

Here are five steps to help you make the distinction. Step 1: Link -Motility- and Manometry 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. Of these, 91010 is the most common, with 91011 describing the basic test plus administration of a stimulant (to increase motility) and 91012 describing acid perfusion study in addition to the motility study.

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 is connected to a computer, which records the pressure waves of the esophagus during swallowing. If you see notations in the physician's notes describing these pressure readings, you know you-ve got a manometry procedure. Step 2: Stick With 1 Code 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, gastro-esophageal reflux test; with nasal catheter pH electrode[s] placement, recording, analysis and interpretation), says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga.

In most cases, the physician will leave the catheter in place for about a day, 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 practice, in which you had to distinguish between standard and -extended- pH monitoring.

For example: For pH testing lasting six hours using a nasal catheter, you would report 91034. If the physician leaves the catheter in place for 26 hours, however, the coding would be the same. Step 3: Turn to 91035 for Bravo Probe If your gastroenterologist conducts pH testing using a Bravo capsule, you will turn to 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation) instead of 91034. The Bravo capsule has advantages over a standard catheter pH study, which can include greater patient comfort and the ability to monitor pH levels [...]