Gastroenterology Coding Alert

Question: I wish to know more about billing for a Bravo capsule. I understand that if a Bravo capsule is placed without reading it, you are eligible to bill only for the EGD since placement is considered part of the 26 modifier. Can you bill a Bravo capsule placement separately from the EGD if the Bravo is being read? If so, do you bill them separately or together?

New Mexico Subscriber

Answer: Prior to placement of a Bravo capsule, your gastroenterologist will generally need to perform an EGD. The purpose of the EGD is multiple as it helps your gastroenterologist assess the location of anatomical landmarks such as the lower esophageal sphincter or the squamocolumnar junction to help place the Bravo capsule. The procedure also helps in the assessment of the signs and symptoms that the patient is experiencing.

If the evaluation through EGD prompted the placement of the Bravo capsule, then the EGD procedure is billed on the date that it was placed. You will report it with 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]).

If your gastroenterologist performs a biopsy during the endoscopy, you will need to report it with 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) with the billing date on the day it was performed. If the only reason to perform the EGD is to determine the location for a Bravo placement, then the endoscopic procedure is considered part of the Bravo CPT code and is not separately billable.

The Bravo capsule is read when it is retrieved after a period of about two to four days after it has been placed. You will need to report the Bravo capsule with 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation) with the billing date on the day when it is read.

A modifier 26 (Professional component) is placed if your gastroenterologist is performing the reading (professional component) only. If you are claiming for both the technical and the professional component of the Bravo capsule placement, you will only bill with 91035.