General Surgery Coding Alert

Question: What are the proper CPT and ICD-9 codes to report for using the -gut cam-?

Florida Subscriber

Answer: CPT added 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report) in 2004 to report use of the PillCam, or so-called -gut-cam.-
 
Remember, if your physician provides the professional portion of the procedure only (that is, interpretation and report of the results), you should append modifier 26 (Professional component) to 91110. If your physician provides both the professional and technical components of the procedure, you needn't attach any modifiers.
 
Acceptable diagnoses for using the PillCam vary by payer. Florida Medicare, for instance, will allow 91110 for the following:

- 555.0 -- Regional enteritis; small intestine

- 555.2 -- ... small intestine with large intestine

- 555.9 -- - unspecified site

- 562.02-562.03 -- Diverticulosis/diverticulitis of small intestine with hemorrhage

- 569.85 -- Angiodysplasia of intestine with hemorrhage

- 578.9 -- Hemorrhage of gastrointestinal tract, unspecified.
 
For other states and payers, you-ll have to ask the specific insurer for a list of acceptable diagnoses. Remember, however, that you should only code a diagnosis that clinical evidence supports -- don't simply choose a diagnosis because it gets you paid.