Part B Insider (Multispecialty) Coding Alert

But new codes for Bravo probe, esophageal impedance tests win raves

Sometimes clarity comes at the expense of flexibility.

Providers used to be able to bill for acid reflux tests using two different codes: 91032 and 91033. The second code, for "prolonged services," gave them the ability to obtain extra reimbursement when the tests took longer than usual.

But CPT 2005 deletes both those codes and replaces them with a single code, 91034 (Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode[s] placement, recording, analysis and interpretation). No longer can providers bill separately for a single reading and for a prolonged reading.

One coder, who asked not to be named, says the change came as a huge shock. "It must have been a mistake," the coder exclaims.

But the single new code is more precise and less confusing, claims Eve Chen, billing manager with Digestive Associates of Houston.

Code 91032 was just for the basic test, where the physician inserted the catheter, performed a reading and pulled it out, says consultant Linda Parks in Lawrenceville, GA. It was never clear what length of time constituted a "prolonged service": six hours? Or 24? "It caused a lot of confusion," Parks says.

Meanwhile, coders are welcoming the addition of 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation), which covers the Bravo probe.

Also, new codes 91037 and 91038 cover esophageal impedance studies of less than an hour and between one hour and 24 hours, respectively. The esophageal impedance probe is "more sensitive" and measures more things than the motility test covered by 91010 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study), Parks adds.
 
Enjoy Fewer Unlisted Gastro Codes

The Bravo and esophageal impedance tests previously required unlisted codes, notes Parks. "We had a lot of unlisted codes in gastro," she says. "I'm much happier now."

You can also stop using an unlisted code for balloon distension studies, thanks to the addition of 91040 (Esophageal balloon distension study). This involves inserting a balloon catheter into the esophagus and then inflating it to diagnose non-cardiac chest pain. Don't confuse this test with balloon dilation, experts warn.