Gastroenterology Coding Alert

The "prolonged services" code, 91033, gave gastro offices the ability to obtain extra reimbursement when the tests took longer than usual. But CPT 2005 deleted both those codes and replaced them with a single code, 91034 (Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode[s] placement, recording, analysis and interpretation). Providers can no longer bill separately for a single reading and for a prolonged reading.

One coder, who asked not to be named, says the change came as a huge shock. "It must have been a mistake," the coder says.

Other Signs of Acceptance for 91034

While there is certainly still resistance to 91034, at least one other coding expert agrees with Chen's assertion that things are much easier with the new single code.

Questions on how to use 91032 and 91033 were omnipresent, which is why CPT tried to come up with a simpler code, says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga.

"Code 91032 was just for the basic test, where the physician inserted the catheter, performed a reading and pulled it out," Parks says. The major problem was that the code description never clarified exactly what length of time constituted a "prolonged service." Did prolonged service begin at six hours? Or 12? Or 24?

When an office tried to figure out prolonged service time on its own, "it caused a lot of confusion," Parks understates.

Bravo, Esophageal Impedance Tests All Good

Meanwhile, Parks says she welcomes the addition of new codes for Bravo probe (91035, Esophagus, gastro-esophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation) and esophageal impedance (91037, Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode[s] placement, recording, analysis and interpretation; and 91038, ... prolonged [greater than 1 hour, up to 24 hours]).

Why? The Bravo and esophageal impedance tests previously required unlisted-procedure codes, which no coder wants to use on a claim. "We had a lot of unlisted codes in gastro. I'm much happier now," Parks says.