Gastroenterology Coding Alert

Question: In volume 12, number 10 of the Gastroenterology Coding Alert, a reader asked about which codes to use when billing a Bravo capsule placed during EGD. To my knowledge, 91035 includes endoscopy. However, the answer given in the reader's question was to bill 43235 and 91035. Can you clarify this?

Michigan Subscriber

Answer: What was not made clear in the simple answer provided was the billing dates for each code. In general, a physician needs to perform an EGD to evaluate the symptoms which are also prompting the use of a Bravo capsule. In order to place a Bravo capsule the physician needs to know the location of the lower esophageal sphincter or squamocolumnar junction. This is where it gets tricky.

When an endoscopy is performed to investigate symptoms then the endoscopy procedure will be billed on the date it was performed with the ICD-9 code representing the patient's symptoms. The CPT code might be 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) or 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple), depending on the service. At the same session the physician might also decide to place a Bravo capsule using the measurements obtained during the endoscopy (billable with 91035, Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation). The date of service for the claim for the Bravo capsule will be when the recorder is retrieved 2-4 days later and the physician is sure that data was captured for analysis.

However, if the gastroenterologist performed an endoscopy recently (roughly within several months) to evaluate the symptoms at some date prior to Bravo placement, then it should not be necessary to repeat it just to get the location needed for the Bravo capsule placement. The second endoscopy would not be medically necessary and therefore not separately billable. You should include this in the Bravo claim.