Gastroenterology Coding Alert

Question: Our gastroenterologist saw a patient suffering from recurrent heartburn that had not subsided with lifestyle changes and acid suppression medications that we prescribed six weeks ago. The physician advised the patient to stop medications for one week and ordered a pH monitoring test. After 24 hours, the patient came back and our gastroenterologist retrieved the data for interpretation. Which code applies?

Delaware Subscriber

Answer: Report the procedure with 91034 (Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode(s) placement, recording, analysis and interpretation).

If your physician performed a significant and separate E/M service on the same calendar date as the pH monitoring test, you can report the E/M service separately by appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code.

If the outpatient hospital owns the equipment for the pH study and their personnel perform the service, the billing from the physician providing the interpretation is 91034 with 26 modifier (Professional component), while the hospital will bill 91034-TC (Technical component…).