Gastroenterology Coding Alert

Question: Our gastroenterologist met a patient with esophageal reflux at the hospital and performed a 10-hour pH monitoring to check for gastroesophageal reflux disease (GERD). We have not coded for a pH study yet this year, and we were wondering how payers feel about the new pH monitoring code.

Michigan Subscriber Answer: The code for pH studies may have changed, but everything else has stayed the same when coding the encounters, says Deb Brown, of GI Consultants in Reno, Nev. Her office has reported 91034 (Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode[s] placement, recording, analysis and interpretation) to several different carriers - and has had no problems so far. Brown says coders should apply the same rules to diagnosis coding and documentation for pH study encounters as they did in 2004. The only difference should be the CPT code.
 
On the claim, you should:
   report 91034 for the pH monitoring.
   attach modifier -26 (Professional component) to 91034 to show that you are not billing for the technical fee.
   attach ICD-9 code 530.81 (Esophageal reflux) to represent the GERD.
  document any previous treatments or tests the gastroenterologist performed on the patient for the condition. Forget about codes 91032 (Esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux) and 91033 (... prolonged reading). CPT 2005 replaced both codes with 91034.
 
Real-world proof: Brown's office has filed 91034 claims with several carriers and has had no denials
 
"We've been paid for 91034 by Medicare and a couple of private insurers this year, though we still have a few claims out that we have not heard back on," she says. "I'm in charge of reviewing denials, and nothing has come across my desk in terms of denials, so that shows we are getting paid for 91034."
 
Note: For more information on pH monitoring tests, see "Code Most GERD Tests With 91034, 91010" on page 41.  - Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel; and Linda Parks, MA, CPC, CCP, CMSCS, an independent coding consultant in Marietta, Ga.