Gastroenterology Coding Alert

Question: When coding for a video capsule endoscopy (91110), should we bill for the date the capsule was swallowed or for the date the actual report was read by the gastroenterologist? My GI physician reads and submits the report/billing several days after the patient has actually swallowed the capsule.

Texas Subscriber

Answer: If you’re billing a Medicare payer, the date of service for the video capsule endoscopy should be the date the capsule was swallowed even if the provider doesn’t send the claim for a few days while they complete the review and report. According to the CMS document “Capsule Endoscopy Billing and Coding Guidelines,” the date of service “should be entered as the date hook-up is performed, with a number of service of one, regardless of the number of days the recorder is worn.” (https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/30141_14/L30141_GI009_CBG_030112.pdf).

Most patients will return the recorder later on the same date so that there will be verification of data capture within 24 hours, but even if the drop-off is days later, you’ll still report 91110 (Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), esophagus through ileum, with physician interpretation and report) on the hook-up date.

For non-Medicare payers, the coding direction is usually the same in that the date of service would be the day the patient swallows the capsule, but check with your private insurers to be sure.