Gastroenterology Coding Alert

Question: A primary-care physician referred a patient with severe heartburn to one of our gastroenterologists. The doctor examined the patient, conducted an esophageal motility study, and administered an acid reflux test using the Bravo pH Monitoring System. What order of reporting these codes will result in maximum reimbursement?

Louisiana Subscriber Answer: Coding for acid reflux exams is tricky because it involves crucial questions about date of service that need to be addressed specifically and correctly; reporting a consultation on top of that makes this quite a coding quandary.

You should report the esophageal motility study and the consultation on the date of service. First, report the motility study 91010 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study).

For the E/M service, employ a code from the 99241-99245 group (Office consultation for a new or established patient, which requires these three key components ...). Append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the consultation code.

Report the acid reflux test on the day the test results are analyzed. When a gastroenterologist uses the Bravo pH Monitoring System, test results cannot be obtained until at least 48 hours after the procedure. To reflect this passage in time, report 91033 (Esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux; prolonged recording).

Be sure to link any test findings to the appropriate ICD-9 codes. (For example, if esophageal reflux is discovered, include 530.81, Diseases of esophagus; other specified disorders of esophagus; esophageal reflux, in the claim.)

In waiting at least two days to report the acid reflux test, you will sidestep the issue of billing for multiple procedures on the same day. You could run into red tape if a payer decides to get particular about reimbursing for a reflux test, motility study and consultation on the same date of service.

Note: If the doctor performs the acid reflux test in a hospital or ambulatory center, make sure to attach modifier -26 (Professional component) to indicate that you are billing for the interpretation only.  - Clinical and coding expertise for You Be the Coder and Reader Questions provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel; and Linda Parks, MA, CPC, CCP, coding and billing coordinator for GI Diagnostic Endoscopy Center in Marietta, Ga.