Gastroenterology Coding Alert

Question: Our providers bill for the interpretation of the Bravo with 91035/26. The date of service for 91035-26 will be the date the data was interpreted. Our providers will send billing a copy of the actual downloaded report, signed and dated the day of interpretation. Is this sufficient documentation for billing, or does in fact the provider need to dictate a separate interpretation report?

Louisiana Subscriber

Answer: For 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation) claims, most payers are serious about their documentation. Check out the documentation requirements for reporting 91035 from HGSAdministrators (HGSA), the Medicare carrier for Pennsylvania.

Check out these guidelines: According to the HGSA Web site, coders should keep these tips in mind when reporting 91035 to HGSA: 

“Documentation supporting the medical necessity of the procedure, including the requirements listed under the ‘Indications and Limitations of Coverage’ section of this policy, must be maintained in the medical record.”

“Documentation must be maintained in the medical record to support that the patient presents diagnostic problems associated with atypical symptoms or the patient’s symptoms are suggestive of reflux, but conventional tests have not confirmed the presence of reflux.”

“Documentation must be available to Medicare upon request (e.g., physician interpretation and report).”