Gastroenterology Coding Alert

Question: Our patient came in for a capsule endoscopy, but the capsule got stuck in food on hour five and visuals could not be seen past the stomach. Our protocol is that the patient can eat a light lunch two hours after ingestion of capsule. This patient ate four hours after swallowing the pill cam. Well have to repeat this to see if we can see the small and large intestine. How should we code this procedure?

Hawaii Subscriber

Answer: If your physician is going to repeat the procedure, append modifier 53 (Discontinued procedure) to 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report).

Another option: If you werent going to repeat the procedure, you could append modifier 52 (Reduced services) to reflect that the capsule imaged the patients anatomy until it became lodged in the food.

Whose equipment? For 91110, make sure your place of service is where the capsules data was downloaded. If your practice owns the equipment and capsule (and not a facility), check that your place of service was the office (POS code 11). If a facility provided the capsule, then append modifier 26 (Professional component) to 91110 -- you can code only for the professional component of the service. The facility will also code 91110 and append modifier TC (Technical component).