Gastroenterology Coding Alert

Question: Regarding the Bravo pH Monitoring System, when the physician places the device by EGD, should I bill 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]), 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]), and 91033 (Esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroe-sophageal reflux; prolonged recording)? Then, should I bill 91033-26 for the interpretation 48 hours later? New Jersey Subscriber Answer: The Bravo pH Monitoring System measures esophageal pH levels in patients who may have gastroe-sophageal reflux disease (GERD). It involves the temporary intranasal or intraoral placement of a small capsule-size probe onto the wall of the esophagus, where it remains in place for up to several days.

CPT contains two codes for the acid reflux test:
91032 Esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroe-sophageal reflux
91033 prolonged reading. Because the Bravo system is a prolonged test, use the reading code, 91033. For best reimbursement, report 91033 when the gastroenterologist completes the test and analyzes the results. If the physician conducts the test in a hospital setting or ambulatory surgical center, append modifier -26 (Professional component) to indicate that the doctor does not own the equipment and is billing for the interpretation only.

You should report 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) if there was an accepted indication for the procedure such as chronic heartburn or abdominal pain. The gastroenterologist places the Bravo device after the procedure based on the measurement to the gastro-esophageal junction. It is not clear if the endoscopic code can be reimbursed when the physician previously performed another endoscopy, and the immediate pre-Bravo procedure was performed solely to determine the measurement for Bravo code placement.

Reimbursement for the disposable Bravo capsule depends on carrier discretion, as there is no specific supply or "pass-through" code. You could use 99070 when coding for placement of the Bravo capsule when the physician provides the service in the office setting. The facility would use an unlisted supply code pertinent to hospital or ambulatory surgery centers and would also bill for the technical component of the Bravo pH service with 91033-TC. Clinical and coding expertise for You Be the Coder and Reader Questions provided by Linda Parks, MA, CPC, CCP, coding specialist at GI Diagnostics Endoscopy Center in Marietta, Ga; and Michael Weinstein, MD, a gastroenterologist [...]