Gastroenterology Coding Alert

Question: We recently purchased the PillCam™ Given Capsule technology to use with colonoscopies. What should I expect in the way of reimbursement, and how should we code for this procedure?

Virginia Subscriber

Answer: PillCam^TM Given® Diagnostic Imaging System, (previously called M2A®), is a disposable imaging capsule manufactured by Given Imaging, Ltd (Norcross, GA) used for Wireless capsule endoscopy. Gastroenterologists resort to this technology to diagnose specific gastrointestinal disorders.

Based on the extent of anatomy studied and reviewed by the physician, you can use any of the following codes:

• 91110 (Gastrointestinal tract imaging, intraluminal [eg, capsule endoscopy], esophagus through ileum, with physician interpretation and report) -- for the examination of the upper gastrointestinal tract;
  
• 91111 (Gastrointestinal tract imaging, intraluminal [eg, capsule endoscopy], esophagus with interpretation and report) -- for the examination of only the esophagus with a specialized bi-directional PillCam^® ESO;
  
• 0355T (Gastrointestinal tract imaging, intraluminal [eg, capsule endoscopy], colon, with interpretation and report) -- for the examination of the colon and for imaging of distal ileum, when performed with a PillCam^® COLON.
  

However, before coding the capsule endoscopy, check your local payer guidelines thoroughly for acceptable diagnosis codes. For example, Blue Cross & Blue Shield of Mississippi® considers the procedure non-payable if performed for the following reasons:

• Evaluation of the extent of involvement of known Crohn’s disease or ulcerative colitis
  
• Evaluation of the esophagus, in patients with gastroesophageal reflux (GERD) or other esophageal pathologies
  
• Evaluation of other gastrointestinal diseases and conditions not presenting with GI bleeding including, but not limited to, celiac sprue, irritable bowel syndrome, Lynch syndrome, portal hypertensive enteropathy, small bowel neoplasm, and unexplained chronic abdominal pain
  
• Evaluation of the colon including, but not limited to, detection of colonic polyps or colon cancer
  
• Initial evaluation of patient with acute upper GI bleeding.
  

For complete information on the policy, you can visit http://www.bcbsms.com/com/bcbsms/apps/PolicySearch/views/ViewPolicy.php?&noprint=yes&path=/policy/emed/Wireless+Capsule+Endoscopy+as+a+Diagnositc+Technique+in+Disorders+of+the+Small+Bowel+Esophagus.html#Top .