Gastroenterology Coding Alert
Designate Separate E/M with 25
Question: During a meeting with a patient complaining of heartburn, my gastroenterologist performed an expanded, problem-focused history and examination with straightforward decision making. The doctor ordered several lab tests and discussed diagnostic and treatment options with the patient. The gastroenterologist also ordered a pH study and manometry to determine if the patient is a good candidate for further surgical treatment. Which codes should I report? California Subscriber Answer: In this case, you should report 99202 (Office or other outpatient visit for the evaluation and management of a new patient ...) for the E/M visit. Then, once the tests are completed, report 91034 (Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode(s) placement, recording, analysis and interpretation) for the pH study and 91010 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study) for the manometry. If the tests happen to be performed on the same day as the office visit, then you should append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service) to 99202 to indicate that your gastroenterologist performed a significant, separately identifiable E/M service that should not be included in the procedure codes you are reporting.
Gastroenterology Coding Alert
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