Gastroenterology Coding Alert

Getting reimbursed for esophageal manometry and acid reflux studies performed on the same date of service has become more difficult, according to many Gastroen-terology Coding Alert readers. Many coders who frequently bill these tests advise that the way around this coding dilemma is to report the tests as of the date they were completed instead of when they were initiated.

Esophageal manometry (91010) is used to evaluate neuromuscular disorders of the esophagus. A small catheter with water flowing through it is placed in the patient's esophagus and inserted into the stomach. The catheter is then withdrawn at half-inch intervals while a pressure profile of the lower esophageal sphincter is taken at each point.

During an acid reflux test (91032 and 91033), which is also referred to as pH monitoring, a catheter probe is passed through the patient's nose and down to the distal esophagus. Attached to the other end of the probe is a cassette worn on the belt that records the extent of the acid reflux. After the cassette is activated, the patient is sent home and is usually asked to return in 24 hours, and the probe is removed.

Both tests are usually administered by a nurse or technician, regardless of whether the setting is a hospital, ambulatory service center or office. The test results are compiled and presented to the gastroenterologist, who then reads or interprets the results. Date of Service When Test Is Read It is not unusual to first administer the esophageal manometry test and then insert the probe for the acid reflux test during the same session. Some gastroenterology practices bill both tests on the same date of service and have no problems getting reimbursed.

"We report multiple tests on the same day and don't do anything to distinguish that they are separate like using modifier -51 [Multiple procedures] or -59 [Distinct procedural service]," says Kimberly B. Green, CPC, project coordinator at the University of Pittsburgh Physicians where she works with 25 gastroenterologists. "I've seen questions about what date of service should be used and wondered if we were doing this right, but I've never seen anything in writing from Medicare or CPT about what to do."

Other practices use the date that the gastroenterologist interprets the test results as the date of service, which sidesteps the issue of billing for multiple procedures on the same day. "Our date of service is the day that the test is completed," says Jill Barron, CPC, coding manager at Gastroenterology Associates of Cleveland Inc. "The gastroen-terologist gets called over to the hospital to read the test results either the day the test is administered or the day after, if it's a 24-hour pH study, so when we [...]