Gastroenterology Coding Alert

Question: Our GI performs an esophageal balloon distension study on a patient who complains of frequent chest pain. However, the test does not include provocation. How do we report this procedure?

Mississippi Subscriber

Answer: This study helps the provider determine whether a patient’s chest pain results from esophageal or cardiac causes. The provider inserts a balloon dilator through the mouth and into esophagus, inflating the balloon multiple times at different points along the esophagus and records the pain response. The provider may administer a chemical agent to elicit a reaction in the esophagus; and to indicate that the likely cause of the patient’s chest pain is esophageal and not cardiac.

You may report 91040 (Esophageal balloon distension study, diagnostic, with provocation when performed) in this case. This is a diagnostic procedure, and it does not require the performance of provocation to report this procedure. Not all patients undergo provocation during the performance of the study. Provocation refers to application or instillation of some type of chemical agent to elicit a response.

According to the AMA guidelines, do not report 91040 more than once per session.

Plus: If you are reporting only the professional component for the service, you should append professional component modifier 26, (Professional component) to the code.

If you are reporting only the technical component for the service, you should append modifier TC (Technical component) to the code unless the hospital provided the technical component. In that case, do not append modifier TC because the hospital’s portion is inherently technical.

Do not append a professional or technical modifier to the code when reporting a global service in which one provider renders both the professional and technical components.