General Surgery Coding Alert

Question: While performing an esophagoscopy, our surgeon placed a Bravo capsule to monitor pH at the esophageal sphincter to help assess the patient for suspected gastroesophageal reflux disease (GERD). How should we code the endoscopy and the Bravo capsule test?

Georgia Subscriber

Answer: The appropriate code for the Bravo capsule test for pH monitoring is 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation). To insert the Bravo capsule, it is necessary to know the distance from the teeth to the lower esophageal sphincter. Your surgeon might need to perform endoscopy on the day of the Bravo insertion if he does not know the distance. If the sole purpose of the endoscopy is to place the Bravo capsule, then you should not separately report an esophagoscopy code.

But if the surgeon documents that it is medically necessary to perform an esophagoscopy to evaluate symptoms in addition to determining the location for placing the Bravo capsule, then you can additionally bill the endoscopy.

You need more information than you’ve provided to select the proper esophagoscopy code. If the surgeon uses a rigid scope, you should select a code such as 43191 (Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure)) for the diagnostic scope, or a different related code if the surgeon performs any other services such as taking a biopsy.

If the surgeon uses a flexible scope, you’ll need to know if the approach is transnasal or transoral so you can select the proper code, such as 43197 (Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)) or 43200 (Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)).

Date difference: You should bill 91035 on the day the doctor interprets the test, which is typically 48 to 72 hours after placing the capsule.