Gastroenterology Coding Alert

Yellow cover is just the beginning of changes Starting in January, gastro coders should think twice before reporting a pair of codes for an esophageal acid reflux test, because CPT 2005 has made the procedure a one-code affair - regardless of the recording time.

The Coding Institute has procured an advanced copy of CPT 2005. The AMA changed the cover color, from 2004's fire-engine red to canary yellow this year, but gastroenterology coders will be more interested in what's inside. CPT 2005 includes several alterations to gastro-specific code groups that you will need to learn before Jan. 1, 2005, when you must begin using the new codes.

When you start using that new calendar in January, gastroenterology practices will see changes in how they code for the following procedures, says Robert B. Cameron, MD, FACG, of the American College of Gastroenterology and the AMA/CPT Advisory Committee:

  esophageal Ph measurement
  esophageal impedance
  rectal and esophageal balloon distention
  breath hydrogen testing
  endoscopic therapy for esophageal reflux. Report 1 Code for Reflux Tests When a patient reports to your office next year for an esophageal acid reflux test with either a disposable or reusable nasal catheter, you should use 91034 (Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode[s] placement, recording, analysis and interpretation) in all instances.

To make room for 91034, CPT has deleted two codes:
91032 - Esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux
  91033 - ... prolonged reading. Why? CPT deleted 91032 because it was used to report only a single measurement of pH and was rarely used, Cameron said at November's CPT 2005 Coding Symposium in Chicago.

Tests With Bravo Probe Get Separate Code  CPT 2005 also offers up 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation) for when your gastroenterologist performs a Bravo probe while conducting a reflux test. 

When should I use it? Consider this example from the AMA's CPT Changes: An Insider's View 2005. 

"A male presents with severe chest pain. A thorough cardiac evaluation suggested no cardiac abnormality. The patient was placed on pharmacological agents, but symptoms have persisted. An upper gastrointestinal endoscopy (EGD) revealed mild, distal esophageal erythema, otherwise unremarkable."

In this instance, you should report 91035 - after Jan. 1, of course.
 
Measuring Esophageal Impedance Just Got Easier Get ready to use a pair of codes for coding esophageal impedance studies in 2005, which should make reporting these tests less confusing than before:
  91037 - Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation
  91038 - ... prolonged (greater than 1 hour, up to 24 hours).

"These are new codes for nasal catheter intraluminal impedance measurements of the esophagus. [...]