Gastroenterology Coding Alert

Question: In a previous issue of the “Gastroenterology Coding Alert” you have mentioned that for capsule endoscopy, the date of service should be same for professional and technical component of the service although interpretation is provided on a later date. I found an MLM matters article on one of the MAC sites which states that the DOS of the PC component should be on the date of interpretation. Is the information provided by you incorrect?

West Virginia Subscriber

Answer: The MLM matters article that you are referring to seems to be “MM6375” effective date Jan.4, 2010. This article states the date of service for a code that has a professional component and a technical component should follow the date on which the respective services were provided.

However, this MLM article and the related change request “CR 6375” were rescinded on Feb. 5, 2010. There was a note saying that the information and guidelines regarding the date of service will be clarified at a later date, but there has been no further update till now.

So, you will have to overlook the information provided in this MLM matters article and continue to use “date of service” as you were doing prior to the date on which this particular article was released.

You will therefore need to maintain and submit the claim with the date of service of both the professional component and the technical component as the same date. So, as per this, the information provided in the previous issue of the “Gastroenterology Coding Alert” on providing the same date of service for the professional and technical component of capsule endoscopy is correct.

Bottom line: If your physician reads a capsule study that the patient completed at a hospital location, you will have to report the date of service for capsule endoscopy professional reading component as the date on which the capsule was swallowed by the patient.

For example, suppose the patient swallowed the capsule on 12/12/2013, and your clinician interpreted the results on the 14^th.You will report the date of service for the professional component the capsule endoscopy with 91110-26 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with interpretation and report; Professional component) on the 12^th. You would report 91110-TC (Technical component) on the 14^th for the interpretation.

To clarify that the MLM matters article was rescinded, please check the link at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM6375.pdf .