Gastroenterology Coding Alert

Also, include documentation of other treatments doctor tried

If you're now reporting gastroesophageal reflux tests the same way you did in 2004, you should be on the lookout for possible denials for these claims.

Why? CPT changed the reporting rules for reflux tests. From now on, when the gastro performs a reflux test and reading lasting less than 24 hours, you should use new code 91034 to report the service.
 
Read on for a rehash on what goes into a really fine reflux test claim. Use 91034 Regardless of Time The old method for reporting reflux tests relied on a pair of codes. Before 2005, coders reported reflux tests with 91032 (Esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux) and 91033 (... prolonged reading), depending on the encounter. CPT does not include either of these codes in its latest manual, so you should forget that they ever existed.

Now you should report reflux tests with 91034 (Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode[s] placement, recording, analysis and interpretation), said Robert B. Cameron, MD, FACG, of the American College of Gastroenterology and the AMA/CPT Advisory Committee, during November's CPT 2005 Coding Symposium in Chicago.

The 91034 code covers pH electrode placement "that ideally will record esophageal pH for a 24-hour period or less," Cameron said. Heartburn, Asthma May Prompt Reflux Test As an illustration of how to use code 91034, consider this example. A patient with a history of heartburn reports with severe heartburn six weeks after his last appointment, during which the gastroenterologist had recommended some lifestyle changes aimed at reducing the heartburn.

The patient reports that the changes have failed to stop the heartburn, so the gastro performs a gastroesophageal reflux test, recording the patient's esophageal pH for 10 hours.

On this claim, you should:
   report 91034 for the reflux test with a date of service that reflects the day the gastro collected the data.
  attach ICD-9 code 787.1 (Heartburn) to 91034 to prove medical necessity.
   include documentation that explains other courses of treatment the physician attempted before the reflux test. (In this case, the notes should include the lifestyle changes the gastro recommended to the patient, evidence of the lifestyle changes' ineffectiveness, and any other actions the gastro took to combat the heartburn). Other acceptable diagnoses:

While this is not a complete list, other ICD-9 codes that may prove medical necessity for 91034 include:    493.82 - Cough variant asthma
   530.10 - Esophagitis, unspecified
   530.2x - Ulcer of esophagus
   530.85 - Barrett's esophagus
   786.2 - Cough
   786.59 - Chest pain; other. Remember: Most payers consider these ICD-9 codes acceptable diagnoses for reflux tests, but your carrier may not. If you are unsure about the appropriateness of an ICD-9 code, double-check your contract - or call the payer and ask. Don't Skimp on [...]