Gastroenterology Coding Alert

Need another road sign? Look for tests lasting one hour versus nearly 24Which esophageal function test you code -- or leave off your claim altogether when reported with other esophageal test -- relies on clue words in your physician's documentation, such as "multi-purpose," "manometer" or "disposable."Discover what esophageal function test, motility tests and pH studies really mean, and how they differ, and your esophageal claims will sail through the reimbursement process.Codes 91037-91038 Mean Impedance CatheterYou have two specific codes to describeesophageal function (impedance) tests:• 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).What happens: The GI physician transnasally inserts an impedance catheter. The test measures bolus transit dynamics with either pH measurement or esophageal muscular function in the evaluation of symptoms including chest pain, swallowing difficulty, or chronic heartburn unresponsive to medication. Physicians can perform these tests in combination with manometry or pH testing, says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT advisory panel.Important: The descriptors for 91037 and 91038 include time measurements. For instance, you should apply 91037 for testing that lasts up to one hour -- even when the multi-purpose impedance catheter also measures esophageal motility. If the monitoring lasts more then one hour, you should look to 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.Scenario: The gastroenterologist inserts the nasal catheter to record esophageal impedance and pH measurements 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 along with 91034, Weinstein says.Catch this: Although both motility studies and function (impedance) testing use a nasal catheter, the esophageal impedance probe is multi-purpose and measures more things than the motility test covered by 91010 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study) or the gastroesophageal reflux test covered by 91034.Equate Manometry With Motility StudiesWhen you see manometry, think "motility studies."Scenario: A patient reports to your office with symptoms that could indicate gastroesophageal reflux disease (GERD), but he doesn't have typical endoscopy findings or improvement with acid-suppression medication. Your gastroenterologist may try manometric studies to determine the patient's condition. That usually means 91010.What happens: 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 [...]