Gastroenterology Coding Alert

Which 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.

You have two specific codes to describeesophageal function (impedance) tests:

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.

When 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 into the esophagus. The manometry catheter is connected to a computer, which records the pressure waves of the esophagus during swallowing. If the physician's notes describe these pressure readings, you've got a manometry procedure.

Exceptions: You'll report most manometric studies with 91010, but you won't find any separate CPT codes for special manometries. If your physician performs a manometry with:

• a stimulant, report 91011 (... with mecholyl or similar stimulant) instead of 91010.

• acid perfusion, report 91012 (... with acid perfusion studies) instead of 91010.

Combination with impedance: When the gastro-enterologist combines this impedance test with manometry (multichannel intraluminal impedance and manometry, MII-EM), he can examine information on detected contractions' functional (bolus transit) component. The gastroenterologist can also look at pressures.Tip: Altogether, this test lasts less than one hour.

Because the Correct Coding Initiative (CCI) has no edit barring you from reporting impedance test codes (91037-91038) and the manometric studies (91010-91012) together, you can report both services.

When your gastroenterologist provides an esophageal acid reflux test using either a disposable or a reusable nasal catheter, you should report 91034 (Esophagus, gastroesophageal 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 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.

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, the coding would be the same.

Exception: 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, including greater patient comfort and the ability to monitor pH levels over a longer time period.

Combination with impedance: When the physician combines an esophageal impedance test with a pH, he can detect gastroesophageal reflux independent of pH (meaning both acid and non-acid bile reflux), Weinstein says. Note: This test can take up to 24 hours.

Because CCI bundles the impedance test codes (91037-91038) into the pH test, you'll report only 91034 or 91035. CCI does not allow you to override this edit with a modifier.