91035 for ASC Billing

helenadutoit

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Tracys Landing, MD
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Please help!!
This is what I have received from the Materials Manager of the ASC that I am coding for: What makes it interesting, is the fact that he sent it off to all the physicians, the CFO, the administrator and billing staff, but not to me, the coding consultant. Makes me wonder. What should my response be?

"I would just like to inform everyone that since 2015, Bravo pH study reimbursement had changed. We used to not be able to bill as an ASC on the interpretation of the study (CPT code 91035) but now we can for as long as the procedure (EGD with or without biopsy) were done as "diagnostic". Thanks to Dr. X who had persuaded me to inquire further from the manufacturer... below are some information that their coding consultant had provided. Hope this is helpful.



· Medicare covers 91035 in the ASC setting only as an ancillary service integral to a covered surgical procedure. If performed solely for the purpose of placement of the Bravo capsule it is not a billable service in this setting. For the professional fee if the EGD is completed solely for placement purposes it should not be billed in addition to 91035.

· Both facility and physician may report a charge for the diagnostic procedure and Bravo when the EGD meets the modifier 59 multiple procedure definition of “separate and identifiable.” When reporting a charge for both procedures the NCCI (National Correct Coding Initiative) edit dictates that modifier 59 be amended to the diagnostic procedure code.



bravo located at ASC
Bravo
Diagnostic EGD

Facility (ASC) Procedure Charge
91035
43235 or 43239

Site of service
24
24

Date of service
Date procedure is performed
Date procedure is performed

Professional Charge
91035-26
43235 or 43239

Site of service
24
24

Date of service
Date of report interpretation
Date procedure is performed




Payment rates listed below reflect the CMS (centers for Medicare and Medicaid services) national rate; they are not regionally adjusted. Rates are current as of the April 2016 fee schedule publication. Please consult your contracts for commercial Rates.



Procedure Code
Description
Physician Office
Ambulatory Surgical Center
Hospital Outpatient Department

91035 Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation $484.79

Professional Only (26): $85.57 Technical Only (TC): $399.22 $222 $396.52

43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
Non-Facility: $316.51

Facility: $134.27 $416.80 $745.36

43239 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) with biopsy, single or multiple Non-Facility: $403.87

Facility: $151.45 $416.80 $745.36"
 
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Maybe you were mistakenly forgotten? Maybe this person thought you'd already know the information? If I was going to respond about it, I'd just be upfront and ask if I was inadvertently left off the mailing list and request a copy be sent to me to add to my "resources" or something similar. If you approach it with the assumption that is was just an error rather than an intentional act, there'd be no finger-pointing.
 

helenadutoit

Networker
Messages
53
Location
Tracys Landing, MD
Best answers
0
That is an interesting take on the issue. I have spoken to the billing manager who reached out to me and it was an intentional act unfortunately, but, I'm fine with it. It is not my job to tell them how to bill anyway. It is my job to do the coding and do it by rules, it is their prerogative to follow my queue or not. You can take a horse to the water, but you cannot make it drink. All is good and everybody is happy.
 
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