Gastroenterology Coding Alert

Question: What is the code for placing a small bowel capsule by way of an EGD?

Answer: You'll code 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]) for the EGD and 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report) for his interpretation of the wireless capsule data.

Take care: For 91110, make sure your place of service is where the capsule's data was downloaded. If it's your practice's equipment and capsule (and not a facility's),check that your place of service was the office (11). If a facility provided the capsule, then append modifier 26 (Professional component) to 91110 -- you can code only for the professional component of the service. Some carriers require you to append modifier 52 (Reduced services) on 91110 when it is placed by EGD.