Gastroenterology Coding Alert

Catheter test aims to pinpoint chest pain The latest version of the CPT manual will make things easier on gastroenterology offices reporting balloon distention studies for patients with non-cardiac chest pain.

If your gastro performs a balloon distension in 2005, you should report the procedure with new code 91040 (Esophageal balloon distension provocation study). This code will premiere in the AMA's CPT 2005 manual.

When treating patients with non-cardiac chest pain, the gastroenterologist will often perform a test designed to elicit chest pain in a patient in order to diagnose the condition. In this procedure, the gastro sends a balloon catheter into the esophagus and inflates it with water or air to prompt chest pain.

"This is useful in patients with unexplained non-cardiac chest pain and dysphagia. The test is positive if it reproduces a previously unexplained chest pain," says Robert B. Cameron, MD, FACG, of the American College of Gastroenterology and the AMA/CPT  Advisory Committee.

Warning: Cameron reminded coders not to confuse this balloon distension test with balloon dilatation procedures.

When your physician performs a balloon dilatation procedure in 2005, you should still choose from the following codes depending on the GI area and the situation:

  43220 - Esophagoscopy, rigid or flexible; with balloon dilation (less than 30-mm diameter)
  43249 - Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with balloon dilation of esophagus (less than 30-mm diameter)
  43456 - Dilation of esophagus, by balloon or dilato, retrograde
  43458 - Dilation of esophagus with balloon (30- mm diameter or larger) for achalasia. Rectal Test Given Its Own Code When your gastroenterologist performs tests for rectal sensation, tone and compliance in 2005, report the procedure using the new code 91120 (Rectal sensation, tone and compliance test [i.e., response to graded  balloon distention] ).

Who needs it? This test "measures the sensory, motor and biomechanical function for the rectum in patients with irritable bowel syndrome, constipation and/or fecal incontinence," Cameron says.

Example: The following scenario would be reported with 91120, according to CPT Changes: An Insider's View 2005:

"A patient presents with a three-year history of constipation. She has no desire to defecate and disimpacts her bowel once every 2-3 weeks. On examination, the abdomen is distended. Rectal exam shows impaired rectal sensation and hard stools, of which the patient was completely unaware."