Gastroenterology Coding Alert

Learn if incidental visualizations can be reported separately.

Capsule endoscopy is a medical procedure that utilizes a small, vitamin-sized wireless camera to capture pictures of a patient’s digestive tract. Gastroenterologists typically order this procedure to further investigate a patient’s symptoms and determine the extent of specific problems or diseases.

Find out how capsule endoscopy procedures work and learn what codes to assign for your claim.

What Is a Capsule Endoscopy?

A capsule endoscopy helps visualize the esophagus, stomach, small intestine, and large intestine, which can be challenging to examine using a traditional endoscope. The data collected helps in evaluating the motility of these digestive structures and assessing gastric emptying.

The capsule itself contains an antenna, battery, light source, and tiny camera. The patient swallows the disposable capsule, which then travels through the digestive tract, capturing thousands of colored images. These images are transmitted wirelessly to a data recorder the patient wears on their waist or shoulder. Once the procedure is complete, the images are downloaded to a computer, where the provider can analyze and interpret the data, and prepare a report of their findings.

Providers use this procedure to evaluate patients for gastrointestinal (GI) bleeding, abdominal pain, inflammatory bowel disease, Crohn’s or celiac disease, ulcers, ulcerative colitis, polyps, and tumors. While capsule endoscopies primarily focus on the small intestine, physicians can also visualize the stomach and esophagus to assess conditions like Barrett’s esophagus, esophageal varices, gastroesophageal reflux disease (GERD), and esophagitis.

There are different capsules designed to image different portions of the GI tract. Three types of capsules exist in the industry: esophageal (PillCam ESO, ESO2), small bowel (PillCam SB, SB2, SB3), and colon (PillCam COLON 2) capsules. Additionally, a patency capsule is used to ensure the GI tract is clear of obstructions before performing a capsule endoscopy.

Get to Know the Procedure Codes and Code Instructions

The CPT^® code book contains four codes that cover capsule endoscopies:

• 91110 (Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and report)
• 91111 (… esophagus with interpretation and report)
• 91113 (… colon, with interpretation and report)
• 91112 (Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report)

Note: Code 91113 is out of numerical sequence in the CPT^® code book. Look for it between codes 91111 and 91112.

Instructions listed after each of the codes mentioned above provide you with directions on how to properly report the procedures. For instance, you won’t report 91110 with 91111, 91113, or 0651T (Magnetically controlled capsule endoscopy, esophagus through stomach, including intraprocedural positioning of capsule, with interpretation and report). You’re also instructed to append modifier 52 (Reduced services) if the physician doesn’t visualize the ileum.

Also, pay attention to the code instructions to know which body structures may be visualized during the procedure, but not included in the code descriptor. These incidental visualizations are not separately billed. For example, 91111 includes the instruction, “Incidental visualization of the stomach, duodenum, ileum, and/or colon are not reported separately.”

Dive Into These Procedure Descriptions

Determining the correct capsule endoscopy code can be tricky if you’re unfamiliar with what the procedure entails. Look through the following descriptions to better understand 91110-91113.

Code 91110: The patient is prepped, and image recording sensors are placed on the patient’s abdomen. The provider gives the patient an activated endoscopic capsule to swallow with water. As the capsule passes through the digestive tract, it takes color images of the esophagus to the ileum. The capsule’s antenna sends images to the recording device. After eight hours, the patient removes the recorder and returns it to the provider. A complete procedure requires image recording from the esophagus to the terminal ileum. The capsule exits the patient’s body with a bowel movement within 24 to 48 hours. The provider transfers the data from the recording device to a computer. The provider analyzes and interprets the data and prepares a report.

Code 91111: The patient is prepped, and image recording sensors are placed on the patient’s abdomen. The provider gives the patient an activated endoscopic capsule to swallow with water. The capsule passes through the esophagus, taking color images of the esophagus. The capsule’s antenna transmits images to the recording device. After eight hours the patient removes the recorder and returns it to the provider. The capsule exits the patient’s body with a bowel movement within 24 to 48 hours. The provider transfers the data from the recording device to a computer. The provider analyzes and interprets the data and prepares a report.

Code 91112: The patient is prepped, and image recording sensors are placed on the patient’s abdomen. The provider gives the patient an activated endoscopic capsule to swallow with water. This capsule takes color images of the stomach through the colon, measuring the pressure and strength of the contraction waves from the time it reaches the stomach to when it is expelled with a bowel movement. The capsule exits the patient’s body with a bowel movement within 24 to 48 hours. The provider transfers the data from the recording device to a computer. The provider analyzes and interprets the data and prepares a report.

Code 91113: The patient is prepped, and image recording sensors are placed on the patient’s abdomen. The provider gives the patient an activated endoscopic capsule to swallow with water. The capsule passes through the digestive tract, taking color images of the colon (the large intestine). The capsule exits the patient’s body with a bowel movement within 24 to 48 hours. The provider transfers the data from the recording device to the computer. The provider analyzes and interprets the data and prepares a report.

Don’t Forget Modifiers When They’re Needed

Codes 91110-91113 include both professional and technical components. If only the professional interpretation component is being performed, add modifier 26 (Professional component). If only the technical component is performed, add modifier TC (Technical component …). No modifiers are needed if both the professional and technical components (global service) are performed.

Examine the Documentation

Before assigning the appropriate procedure and diagnosis codes, you need to carefully read through the physician’s documentation. The medical record must:

• Support the use of the submitted CPT^® and ICD-10-CM code(s);
• Describe attempts that were made to identify the source of bleeding, if applicable, but note that the site of bleeding was not previously identified by colonoscopy or endoscopy; and
• Explain why the patient was not a candidate for conventional endoscopy.

At the end of the day, remember these expert coding tips to improve your claim success:

• Choose your endoscopy code based on the specific location(s) imaged.
• Verify local coverage determinations (LCDs) to ensure your diagnosis is covered.
• Know that wireless capsule endoscopy is not reimbursable for colorectal cancer screening.

Lori Carlin, CPC, COC, CPCO, CRC, CCS, Principal at Pinnacle Enterprise Risk Consulting Services