Gastroenterology Coding Alert

Question: A primary-care physician referred a patient with severe heartburn to one of our gastroenterologists. The doctor examined the patient, conducted an esophageal motility study, and administered an acid reflux test using the Bravo pH Monitoring System. In what order should I report these codes to ensure maximum ethical reimbursement?

Kentucky Subscriber
 
Answer: Coding for acid reflux exams is tricky because it involves crucial questions about date of service that need to be addressed specifically and correctly. And reporting a consultation on top of that makes this quite a coding challenge.

You should report the esophageal motility study and the consultation using the date of the office visit as the date of service. First, report the motility study 91010 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study).

For the E/M service, use a code from the 99241-99245 group (Office consultation for a new or established patient, which requires these three key components ...). And be sure to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the consultation code to show that it's a significant separate service from the motility study.

Report the acid reflux test (91035, Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation) on the day your gastroenterologist analyzes the test results. When a gastroenterologist uses the Bravo pH Monitoring System, he can't obtain the test results until at least 48 hours after the procedure.

Be sure to reflect any test findings with the appropriate ICD-9 codes. For example, if your gastroenterologist discovers esophageal reflux, include 530.81 (Diseases of esophagus; other specified disorders of esophagus; esophageal reflux) with the acid reflux test claim.

Good news: By waiting at least two days to report the acid reflux test, you will sidestep the issue of billing for multiple procedures on the same day. You could run into red tape if a payer decides to get particular about reimbursing for a reflux test, motility study and consultation on the same date of service.

Note: If the doctor performs the acid reflux test in a hospital or ambulatory center, make sure to attach modifier 26 (Professional component) to indicate that you are billing for the interpretation only.