Gastroenterology Coding Alert

Question: I've got a rejected claim in front of me that I'm just not sure how to appeal. The operative notes indicate that our gastroenterologist performed an esophageal acid reflux test. On the claim, I reported 91033 (Esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux; prolonged recording) and got this rejection letter. What did I do wrong?


Missouri Subscriber

 
Answer: Code 91033 does not exist anymore, so the rejection is not unexpected. In CPT 2005, there are several changes in the esophageal acid reflux test family of codes.

Impact: Time is no longer of the essence in some reflux test reporting. With certain testing methods, you now choose the code based on the method the physician used when she placed electrodes.

However, you should know that you have access to a prolonged reading code for gastroesophageal reflux tests requiring the use of nasal catheter intraluminal impedance electrode placement.

Given your scenario description, you're going to need some more info before deciding on the best reflux test code. Follow these steps to find the proper code: 1. Go back and look at the operative notes again, checking for total length of encounter and electrode placement method.

2. Choose whichever of these codes is most appropriate:
   Report 91034 (Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode[s] placement, recording, analysis and interpretation) if the gastroenterologist used nasal catheter electrode placement, regardless of the encounter time.
   Report 91035 (... with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation) if the gastroenterologist used mucosal-attached electrode placement, regardless of the time.
   Report 91037 (Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode[s] placement, recording, analysis and interpretation) for testing with nasal catheter intraluminal impedance electrode placement that lasts less than an hour.
   Report 91038 (... prolonged [greater than 1 hour, up to 24 hours) for testing with nasal catheter intraluminal impedance electrode placement that lasts between 1 and 24 hours. 
 
Remember that CPT 2005 does not include 91033 - or 91032 (Esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux), for that matter. Any claim you send out with these codes is ripe for rejection.