Gastroenterology Coding Alert

Because the Bravo system is a prolonged test, use the reading code, 91033. For best reimbursement, report 91033 when the gastroenterologist completes the test and analyzes the results. If the physician conducts the test in a hospital setting or ambulatory surgical center, append modifier -26 (Professional component) to indicate that the doctor does not own the equipment and is billing for the interpretation only.

You should report 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]) if there was an accepted indication for the procedure such as chronic heartburn or abdominal pain. The gastroenterologist places the Bravo device after the procedure based on the measurement to the gastro-esophageal junction. It is not clear if the endoscopic code can be reimbursed when the physician previously performed another endoscopy, and the immediate pre-Bravo procedure was performed solely to determine the measurement for Bravo code placement.

Reimbursement for the disposable Bravo capsule depends on carrier discretion, as there is no specific supply or "pass-through" code. You could use 99070 when coding for placement of the Bravo capsule when the physician provides the service in the office setting. The facility would use an unlisted supply code pertinent to hospital or ambulatory surgery centers and would also bill for the technical component of the Bravo pH service with 91033-TC.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Linda Parks, MA, CPC, CCP, coding specialist at GI Diagnostics Endoscopy Center in Marietta, Ga; and Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel.