Gastroenterology Coding Alert

Question: A new patient reports to the gastroenterologist with complaints of frequent belching and heartburn. After performing a level-two E/M service, the gastroenterologist performs a diagnostic EGD.

Montana Subscriber

Answer: You should be able to report the EGD and the Bravo insertion separately along with an E/M service. On the claim, report the following:

• 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for the EGD

• 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation) for the Bravo cap insertion

• 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making ...) for the E/M

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99202 to show that the E/M was separate from the other procedures

• 787.1 (Heartburn) and 787.3 (Flatulence, eructation, and gas pain) appended to 43235, 91035, and 99202 to represent the patient's symptoms.

Crucial: The date of service for 91035 should be the date the gastroenterologist retrieves the recorder and interprets the capsule data.