Gastroenterology Coding Alert

Although esophageal manometry has been around for approximately 25 years, some gastroenterologists may be unaware that they can be reimbursed for reading and interpreting the results of this diagnostic test.

Gastroenterologists are using esophageal manometry (91010-91012) more frequently because it has become a standard procedure prior to surgery for gastroesophageal reflux disease (GERD) (530.81). With an estimated 19 million Americans suffering from GERD and a public education program being launched by the American College of Gastroenterology to increase awareness of the disease, more gastroenterologists can expect to face problems concerning how to properly code for interpreting their patients manometry results.

Coders Should Understand Procedure

Proper coding often requires the coder to be familiar with the procedures performed. Esophageal manometry is a gastric motility test used to evaluate neuromuscular disorders of the esophagus, explains Kenneth Koch, MD, who teaches manometry as a professor of medicine at Penn State University. This procedure also is used to evaluate unexplained swallowing problems or chest pains, Koch adds. On the other hand, endoscopy looks at disorders of the mucosal lining, such as cancers and ulcers, he says.

During the procedure, a small catheter with water flowing through it is placed into the esophagus through either the patients nose or throat and inserted into the stomach. The catheter is then withdrawn a half-inch at a time while a pressure profile of the lower esophageal sphincter is recorded at each point. In addition, the patient is asked to swallow a teaspoon of water at least 10 times during the procedure to measure the other muscular functions of the esophagus.

The test results resemble those from an EKG, according to Koch, only longer, consisting of about 10 pages of recordings to be interpreted.

Two Components to Reimbursement

Esophageal manometry includes both a technical and a professional component, explains Pat Stout, CMT, CPC, a gastroenterology coding consultant to the American College of Gastroenterologists. The technical component represents the value assigned to the ownership and maintenance of the equipment and the use of any technicians. For a gastroenterologist to bill for the technical component of any diagnostic service, says Stout, he or she must own (or partially own by being a partner in a practice) the equipment being used. If the manometry is done in a hospital setting, then the hospital may bill for the technical component of the test.

The professional component represents the physicians interpretation of the test results. When the gastroenterologist only does the interpretation of the manometry results, Stout says that he or she may bill for reimbursement for the professional component using CPT code 91010 (esophageal motility study) with modifier -26 (professional component).

Criteria to Qualify as an Interpretation

For the test [...]