Gastroenterology Coding Alert

Question: My gastroenterologist performed a "gut cam" or "pill cam" procedure in an outpatient setting. Do I need to use modifier 26?

Oregon Subscriber

Answer: The answer depends on who owns the equipment. If your physician owns the equipment, you do not need a modifier. If the facility owns the equipment, then you will apply modifier 26 (Professional component) to represent the gastroenterologist interpreting and reporting the results.

Keep in mind: If the physician uses a capsule study to image the intraluminal esophagus through the ileum (also including the stomach, duodenum and jejunum), you'll report 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report).

If the physician's study is limited to the esophagus only, you should report 91111 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus with physician interpretation and report). Code 91110 automatically includes 91111, according to CPT.
 
-- Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.