Medicare Compliance & Reimbursement

Question: What can you tell me about coding for a "gut cam" or a "pill cam"? Must I use an unlisted-procedure code for this service?

Answer: You won't have to use an unlisted-procedure code for these services. CPT provides two codes for so-called "pill cams" (essentially, a small camera the patient swallows that provides images for study), depending on how extensive a view the physician obtains.

If the physician uses a capsule study to image the intraluminal esophagus through the ileum (also including the stomach, duodenum and jejunum), you'll report 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report).

If the physician uses an endoscope to place the pill cam for the capsule study, you should append modifier 52 (Reduced services) to code 91110.

Here's why: The descriptor of 91110 clearly states that the evaluation is from the esophagus to the ileum. The endoscopic placement of the capsule makes it technically impossible for the physician to perform the assessment of the esophagus (and potentially the stomach, depending on where the physician deploys the capsule).

If the physician's study is limited to the esophagus only, you should report 91111 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus with physician interpretation and report). Code 91110 automatically includes 91111, according to CPT.

Mind your modifiers: If the physician provides only the professional portion of the procedure (that is, interpreting and reporting the results), you should append modifier 26 (Professional component) to 91110 or 91111, as appropriate.

Various Medicare carriers maintain their own guidelines for reporting these services. For instance, HealthNow, a Part B carrier in New York, publishes a decision for 91110 that notes, "For capsule endoscopy of the esophagus, the record must document that the patient does not have a contraindication for nonselective beta-blocker use."