Gastroenterology Coding Alert

Question: Our gastroenterologist recently performed an esophageal manometry and a diagnostic upper gastrointestinal endoscopy on the same patient during the same encounter. On this claim, should I attach either modifier -51 (Multiple procedures) or modifier -59 (Distinct procedural service) to one of the procedure codes?


Georgia Subscriber


Answer: When reporting an esophageal manometry and an endoscopy during the same session, you do not need any modifiers. On the claim, you should:
   report 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 diagnostic endoscopy
   report 91010 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study) for the esophageal manometry. Heads-up: At times during an esophageal manometry, the gastroenterologist will use a stimulant or conduct an acid perfusion study. If your gastroenterologist performs an esophageal manometry with mecholyl stimulation, for example, you would report  91011 (... with mecholyl or similar stimulant) instead of 91010.

When the gastroenterologist conducts an acid perfusion study with an esophageal manometry, you should report 91012 (... with acid perfusion studies) instead of 91010.