General Surgery Coding Alert

Question: Our surgeon provided gastrointestinal tract imaging with a "gut camera." We have never reported this procedure before, and the only code we can find that approximates the service is a small intestinal endoscopy code. Should we use a small intestinal endoscopy code on gut camera claims?


California Subscriber


Answer: The "gut camera," manufactured by Given Imaging, is now officially called the "PillCam."

Although coders used to report small intestinal endoscopy codes for GI tract imaging with a gut camera, all of that changed with the arrival of 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report).

On the claim, you should report 91110 for the GI imaging if your office owns the Given Diagnostic System recorder and computer.

If your office does not own the Given Diagnostic System, you should report 91110 with modifier -26 (Professional component) appended to show the payer that the surgeon used another facility's system.

If your payer isn't accepting 91110, their code set may be outdated. Before last year, payers accepted GI tract imaging claims with one of two codes:
 

G0262 (Small intestinal imaging; intraluminal, from ligament of treitz to the ileocecal valve, includes physician interpretation and report) for Medicare patients, or
 

44376 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) with modifier -22 (Unusual procedural services) appended for patients with private carriers.
 
However, all payers should now accept 91110 for GI tract imaging. If you get a denial when you use 91110, contact the carrier and make sure it isn't accepting outdated codes.