Gastroenterology Coding Alert

Question: Which code is correct for -M2A capsule-?


North Dakota Subscriber

Answer: The M2A capsule (also called the -GutCam,- -PillCam- or capsule endoscopy) is a -pill- that contains a small digital camera and transmitter. The camera takes a picture twice-per-second as it moves through the GI tract and transmits this information to a recording device worn on the patient's belt.

The patient swallows the capsule in the morning and wears the recording device for about eight hours, after which the physician reviews the images to check the condition of the GI tract.

CPT added a code for this procedure in 2004: 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report).

Code 91110 has both a professional and technical component. Therefore, when reporting only the technical portion of the test, use 91110 and append modifier TC (Technical component). If you are claiming only the professional component of the M2A capsule test, report 91110 with modifier 26 (Professional component). Only if you provide both components of the test should you report 91110 without any modifiers.

Most commonly, insurers will reimburse 91110 with a diagnosis of iron deficiency anemia, but some insurers will reimburse for other conditions, such as Crohn's disease (555.9) or GI bleeding. Check with your individual insurer for allowable diagnoses.