helenadutoit@comcast.net
Networker
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"
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"
