capsule endoscopy placed durring egd for peds patients

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Here is a question about coding capsule endoscopies. These get so confusing to me and we do ALOT of these in the office.

Here is what Im wondering/considering:

This is a pediatric GI office, so quite a few of our patients are too young to swallow the capsule. Therefore, the dr is placing the capsule during an egd in surgery. Im wondering if I should be coding the 91110 ( capsule endoscopy) with a 52 modifier. Since the dr is already doing an egd and places the capsule past the esophagus, would it be a reduced service? The reason for a pill cam is to see the areas that cannot be examined through an egd/biopsy. CPT 91110's descriptor clearly states the evaluation is from the esophagus to the ileum. The only time this won't be true is when the gastroenterologist places the pill cam endoscopically for the study,

ive been coding like this ( by rvu )

91110
43239 51 (egd biopsy)
45380 59 ( colonoscopy)

These are very expensive procedures, so the fact that this is the primary procedure in this case is making me question it.

I should also note that the dr owns the pill cam equipment and takes it to the surgery center where the egd is performed ( so i dont use a modifier 26)

thanks so much!
 

hbeard

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i've run into this situation a lot. it is appriopriate to bill the 91110 with a 52 since the pill is not swallowed and is probably placed directly into the duodenum correct? not using 26 is also correct
 
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