Wiki 91035 & 43239

[veeramani14]

Can 91035 and 43239 be billed in same day?

Is any Modifier applicable for the cpt 91035?

Please anyone clarify me.

Thanks,
Veera.

 

[blathrop19@gmail.com]

I believe you should be able to bill these two procedures together.

The TC/26 modifiers are applicable for 91065 if needed, but I don't believe a multiple procedure modifier is needed for 91035 and 43239 to be billed together.

Bob

 

[JDV7980]

43239 should be billed on the DOS and the 91035 should be billed on the date the bravo is actually completed. The 91035 code includes "placement, recording, analysis and interpretation" so you would have to wait until the 91035 test is completed to report to the ins. At least that is how I read it and have been doing it. This is also how Mcvey seminars instructs their attendees to code/bill it.

Add modifier 26 to 91035 for professional charges, and tc for hospital.

Hope this helps...

 

[01065679]

Simple answer is no

They should not be billed on the same day. The EGD should not be billed at all if it was performed just for the purpose of placing the BRAVO device. See guidelines below...


Prior to placement of a Bravo capsule, your gastroenterologist will generally need to perform an EGD. The purpose of the EGD is multiple as it helps your gastroenterologist assess the location of anatomical landmarks such as the lower esophageal sphincter or the squamocolumnar junction to help place the Bravo capsule. The procedure also helps in the assessment of the signs and symptoms that the patient is experiencing.

If the evaluation through EGD prompted the placement of the Bravo capsule, then the EGD procedure is billed on the date that it was placed. You will report it with 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen by brushing or washing [separate procedure]).

If your gastroenterologist performs a biopsy during the endoscopy, you will need to report it with 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) with the billing date on the day it was performed. If the only reason to perform the EGD is to determine the location for a Bravo placement, then the endoscopic procedure is considered part of the Bravo CPT code and is not separately billable.

The Bravo capsule is read when it is retrieved after a period of about two to four days after it has been placed. You will need to report the Bravo capsule with 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation) with the billing date on the day when it is read.

A modifier 26 (Professional component) is placed if your gastroenterologist is performing the reading (professional component) only. If you are claiming for both the technical and the professional component of the Bravo capsule placement, you will only bill with 91035.