Maximize Reimbursement for Esophageal Acid Reflux Tests
Published on Thu Jun 01, 2000
Patients needing 24-hour pH monitoring of esophageal acid reflux used to be referred to esophageal motility specialists at university medical centers. Because more gastroenterologists have started performing this test themselves, however, they have to deal with the complexities of billing for a procedure that is unlike the more familiar endoscopies and contains both a technical and professional component.
Back in the old days, the university medical centers used to be the only ones doing esophageal motility studies, says Kenneth Koch, MD, who specializes in esophageal motility studies at the Milton S. Hershey Medical Center and Penn State University College of Medicine in Hershey, Pa. These days, however, as gastroenterology practices get bigger and start to approach five to eight gastroenterologists, one physician will often start to develop a specialty in that area.
Contains a Technical and Professional Component
With 24-hour pH monitoring of esophageal acid reflux, a probe is inserted, often by a nurse, into the patients nose and is passed through to the esophagus. The probe is attached to a cassette that records the extent of the acid reflux in the patient for the next 24 hours. After the cassette has been activated, the patient goes home and is asked to record symptoms of acid reflux in a diary.
When the patient returns the next day, the probe is removed. The data on the cassette are downloaded and put in graphic form. The data and the patients diary are then turned over to the gastroenterologist for an interpretation.
The codes for esophageal acid reflux tests, 91032 (esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux) and 91033 (prolonged recording), have a technical component and a professional component. In the Medicare Physicians Fee Schedule database, the relative value units (RVU) for each component are given in addition to the RVU for the full, unmodified code. The technical component is reported by attaching the modifier -TC to the code and the professional component by attaching modifier -26.
Reimbursement for the technical component is billed by the facility that owns the equipment, according to Cynthia Thompson, CPC, senior consultant with Gates, Moore & Co., a healthcare consulting firm in Atlanta. With esophageal acid reflux tests, the technical component consists of the insertion of the probe, the activation of the cassette, the downloading of the data from the cassette, and any instructions provided or questions answered by the person administering the test.
The gastroenterologist who reads and interprets the test bills the professional component, says Thompson. If the gastroenterologist owns the equipment used to administer the test and interprets the test results, he or
she can bill for both the technical and professional components of the procedure [...]
