Gastroenterology Coding Alert

Question: We tried to do a 24-hour pH monitoring of a patients esophageal acid reflux, but could monitor him for only 14 hours. What code do we use to report this service?

Idaho Subscriber

Answer: Two codes can be used to report esophageal acid reflux tests: 91032 (esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux) and 91033 (esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux; prolonged recording).

With pH monitoring of esophageal acid reflux, a probe is inserted 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 several hours. After the cassette has been activated, the patient goes home and records symptoms of acid reflux in a diary. When the patient returns, the probe is removed. The data on the cassette are downloaded and put in graphic form, then the graph of the data and the patients diary are interpreted by the gastroenterologist.

The standard in esophageal acid reflux tests is 24-hour monitoring. Shorter periods can be used, but that is rare. However, some patients may not be able to tolerate 24-hours with a probe inserted in their nose.

Full 24-hour monitoring is the most common procedure and should be reported with the prolonged recording code 91033, states Devon Winborne, CPC, billing coordinator for the Gastroenterology Division at the Georgetown University Medical Center in Washington, D.C. Code 91032 can be used to report monitoring sessions of less than 24 hours, he adds.

Code 91032 is bundled into the prolonged recording code 91033 and should not be reported in addition to code 91033 when reporting a 24-hour monitoring session.