Gastroenterology Coding Alert

Question: If one of our gastroenterologists offers a patient with Crohn's disease the option of an M2A Capsule test, will the Crohn's diagnosis be enough to prove medical necessity to payers?

Ohio Subscriber
 
Answer: Coding for M2A Capsule tests, also known as the PillCam, has come a long way in recent years.
 
In 2004, CPT premiered a code for M2A Capsule tests: 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report). Since then, claims with M2A Capsule tests have gained far more acceptance with payers.
 
Further, Crohn's disease is now an acceptable condition to prove medical necessity for M2A tests, so you should be able to gain payment for tests on your patients with Crohn's.
 
On the claim, you should report 91110 for the M2A Capsule test and attach ICD-9 code 555.9 (Regional enteritis; unspecified site) to represent the patient's Crohn's disease.
 
When filing claims for M2A Capsule tests, remember the following:
 
1. Most carriers will accept 91110, but because it's still a relatively new code, check with an insurance representative before using the code for the first time.
 
2. You should attach modifier -26 (Professional component) to 91110 if your office does not own the test equipment.
 
3. You should attach modifier -TC (Technical component) to 91110 if your office is only providing technical support for the test.