Gastroenterology Coding Alert

Question: A primary-care physician referred a patient with severe heartburn to one of our gastroenterologists. The doctor examined the patient, conducted an esophageal motility study, and administered an acid reflux test using the Bravo pH Monitoring System. In what order should I report these codes to ensure maximum ethical reimbursement?

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Answer: Coding for acid reflux exams is tricky because it involves crucial questions about date of service that need to be addressed specifically and correctly. And reporting a consultation on top of that makes this quite a coding challenge.

You should report the esophageal motility study and the consultation using the date of the office visit as the date of service. First, report the motility study 91010 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study with interpre­tation and report).

For the E/M service, use a code from the 99201-99215 series if the payer doesn’t accept consult codes (Medicare does not accept consult codes, but some private payers still do). If your insurer does accept consult codes and your documentation demonstrates that a consultation took place, you can report a code from the 99241-99245 group (Office consultation for a new or established patient, which requires these 3 key components ...). And be sure to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the consultation or E/M code to show that it’s a significant separate service from the motility study.

Report the acid reflux test (91035, Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation) on the day your gastroenterologist analyzes the test results. When a gastroenterologist uses the Bravo pH Monitoring System, he can’t typically obtain the test results until at least 48 hours after the procedure.

Be sure to reflect any test findings with the appropriate ICD-10 codes. For example, if your gastroenterologist discovers esophageal reflux in the absence of esophagitis, include K21.9 (Gastro-esophageal reflux disease without esophagitis) with the acid reflux test claim.

Note:  If the doctor performs the acid reflux test in a hospital outpatient department which provides the Bravo capsule, make sure to attach modifier 26 (Professional component) to indicate that you are billing for the interpretation only.