Gastroenterology Coding Alert

Question: Can you please tell me what code I should report when our gastroenterologist places a small bowel capsule using EGD. Also, tell me should the date of service be on the day the capsule is placed or on the day the data is read?

West Virginia Subscriber

Answer: When your gastroenterologist uses capsule endoscopy to capture images of the gastrointestinal tract from the esophagus to the ileum, you will have to report the procedure using 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report).

Usually, the patient will swallow the pill cam using water. But, sometimes, your gastroenterologist might resort to placing the capsule endoscopically by performing an EGD to push the capsule beyond the pylorus. In such a case scenario, you have to report the capsule endoscopy study with a modifier 52 (Reduced services) appended to the CPT® code 91110.

This is necessary because the endoscopic placement will not allow the capsule to capture images of the esophagus as your gastroenterologist will place the capsule in the stomach beyond the esophagus. Since the descriptor to 91110 reads "esophagus through ileum" you will have to capture the code with the reduced services modifier appended to it.

You will also have to report the EGD performed with 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]) with the date of service on the day the EGD was performed and the capsule was placed. You will have to report the interpretation of the images read on the capsule with 91110. The date of service for the interpretation should be essentially the date on which the capsule was retrieved and not on the actual date on which the data was interpreted.

If your gastroenterologist is performing the procedure in the outpatient department of a hospital, you have to report only the interpretation part of the procedure with the modifier 26 (Professional component) appended to 91110 while the hospital will claim the technical component by adding the modifier TC (Technical component) to 91110.