Gastroenterology Coding Alert

Question: We just got a chart for an esophageal manometry, but we don’t know what it is or how to code it. Can you advise?

Tennessee Subscriber

Answer: When the GI physician evaluates the patient’s esophagus for neuromuscular disorders, they’ll typically perform esophageal manometry. These studies are used to evaluate how well the esophagus functions, and they may also be ordered to evaluate a patient prior to recommending anti-reflux surgery. The patient’s medical record will probably mention a manometry nasal catheter and pressure readings. You’ll report this procedure with 91010 (Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report). If the outpatient hospital facility’s equipment and staff are used, the physician interpreting the study would bill with the 26 modifier (Professional component) and the hospital would bill 91010 with the TC (Technical component) modifier.

Sometimes, your gastroenterologist might opt for the use of a medication stimulant during the motility studies. In such a scenario, report the additional procedure with +91013 (Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion (eg, stimulant, acid or alkali perfusion) (List separately in addition to code for primary procedure)).

Another test that your gastroenterologist will usually perform while assessing a patient with suspected GERD is pH monitoring, typically over a 24-hour period, using a pH probe placed through a nasal catheter. Such pH studies should be reported with CPT^® code 91034 (Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode(s) placement, recording, analysis and interpretation).

Example: Your gastroenterologist sees a patient suffering from recurrent heartburn that has not subsided with lifestyle changes and acid suppression medications prescribed six weeks prior. The provider advises the patient to stop medications for one week and orders a pH monitoring test. A pH monitoring probe is inserted using an intranasal catheter and the recorder attached to the other end of the probe is activated to capture the data. The GI physician asks the patient to return after 24 hours. Upon return, your gastroenterologist retrieves the data for interpretations. Report the procedure with 91034. Be sure this is not confused with 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation), which is the code for the Bravo capsule study.