Gastroenterology Coding Alert

It's imperative that patients undergo a variety of diagnostic tests before a physician chooses surgical treatment for their gastroesophageal reflux disease (GERD), so coding for these tests needs to become a reflex to you. GERD is a digestive disorder that affects the lower esophageal sphincter (LES), which functionally separates the esophagus and the stomach. Individuals with GERD experience heartburn because the malfunctioning LES allows the stomach's contents to flow back or reflux into the esophagus. Usually, the physician treats symptoms with medication, but sometimes surgery is required for serious cases. Before surgery, however, it is important for the physician to run a battery of diagnostic tests that will help to determine whether the patient is a good candidate for surgery. Incorrect coding for these common procedures can lead to payment problems. Differentiate Between Esophageal Motility Studies Coders often get confused when their physician documents an "acid reflux study" or a "gastric motility study," since these phrases are ambiguous at best. In reality, there are two basic types of motility studies: gastric or esophageal manometry, and pH monitoring. The physician uses esophageal manometry to evaluate neuromuscular disorders of the esophagus. He places a small catheter with water flowing through it into the esophagus and the stomach. Apressure profile of the lower esophageal sphincter is taken at half-inch intervals as the doctor withdraws the catheter.

During a pH study, the physician passes a catheter probe through the nose and down to the distal esophagus. Acassette attached on the other end of the probe records the extent of the acid reflux. After he activates the cassette, the patient is sent home for a usual period of 24 hours for monitoring. The newer Bravo pH Monitoring System involves the intranasal or intraoral placement of a small capsule-size probe into the wall of the esophagus where it transmits data to a small receiver that the patient wears.

You report the first type of study using motility study codes 91010-91020. You will most commonly see 91010 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study).

Report 91032 (Esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux) and 91033 (... prolonged recording) for 24-hour pH monitoring services. Confusion seems to arise concerning the time factor with this service. The general standard for esophageal acid reflux tests is 24-hour monitoring. You should report 91033 for this 24-hour monitoring. Use 91032 for tests that last less than 24 hours. Ownership Is Not a Technicality A nurse or technician usually performs both of these services, and the gastroenterologist interprets the results, says Susan Gruber, CPC, billing manager at a gastroen-terological practice in Hagerstown, Md. But there are technical and professional components to these codes. [...]