Gastroenterology Coding Alert

Question: One of our technicians administered a 24-hour acid reflux test (91033) for a patient in our office, but the test could not be completed. Our patient came back in later that day complaining of extreme discomfort, so we removed the catheter. We were only able to record four hours. How should we code this? Is it adiscontinued service?

Pennsylvania Subscriber

 
Answer: In this case, its not a discontinued service, even though you did not complete the 24-hour test you originally intended. 
 
If your physician read and interpreted the four hours worth of recording you did get, you would use 91032 (Esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux) instead of 91033. Since your physician was able to complete the professional component of this service (the reading and interpreting), you were able to complete procedure 91032 for the time period recorded.
 
Code 91033 is for prolonged recording of the test, which is generally marked as 24 hours. Because 91032 is available, however, you should not code 91033 with modifier -53 (Discontinued procedure).
 
If this service had taken place in a hospital setting in which your practice did not own the equipment used for the test, you would use 91032 with modifier -26 (Professional component).

 
Clinical and coding expertise for You Be the Coder and Reader Questions provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel; Linda Parks, MA, CPC, CCP, coding and billing coordinator for GI Diagnostic Endoscopy Center in Atlanta; and Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.