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Gastroenterology Coding Alert

Reader Question:

Assert Provider's Entitlement For 43235, 91110 Reimbursement

Published on Mon Oct 10, 2011

Question: Our physician places a capsule that we bought through our private practice and he brought over to the surgical center to place via endoscopy. We billed 43235 and 91110-52, and were paid. Later on, however, the insurance company notified us that they were taking back half of our payment on the 91110 stating we should have billed with modifier 26 as the hospital is billing for the same procedure code (91110). I think since we purchased the capsule and own the capsule equipment (belt, recorder and computer), we don't need the modifier 26, and the hospital should not bill for the capsule. Any insights?Colorado SubscriberAnswer: You are correct. If your physician's private practice provided the capsule recorder belt and the capsule for your patient, and then your physician reviewed the belt recording on computer equipment in your office, then the hospital should not be billing the 91110 (Gastrointestinal tract [...]
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