Wiki CPT 91035 is not being paid by the majority of the insurance companies- Why?

Jm6161

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CPT 91035 is not being paid by the majority of the insurance companies. We need to find out how to get this CPT code paid. Do we need to add a modifier, obtain additional prior auths? This is usually billed with CPT 43235. Even when its billed by itself it is being denied. Anyone knows what happen here?
 
Usually its the other way around 91035 is inclusive in 43235. See the NCCI Manual:

2. The gastroesophageal reflux test described by CPT code 91035 requires attachment of a telemetry pH electrode to the esophageal mucosa. If a physician uses endoscopic guidance to attach the electrode, the physician shall not report CPT code 43235 (esophagogastroduodenoscopy,...; diagnostic...) for the guidance procedure. The guidance is not separately reportable. Additionally it would be a misuse of CPT code 43235 since this code does not describe guidance, but a more extensive diagnostic endoscopy.
 
CPT code91035- still confused

Usually its the other way around 91035 is inclusive in 43235. See the NCCI Manual:

2. The gastroesophageal reflux test described by CPT code 91035 requires attachment of a telemetry pH electrode to the esophageal mucosa. If a physician uses endoscopic guidance to attach the electrode, the physician shall not report CPT code 43235 (esophagogastroduodenoscopy,...; diagnostic...) for the guidance procedure. The guidance is not separately reportable. Additionally it would be a misuse of CPT code 43235 since this code does not describe guidance, but a more extensive diagnostic endoscopy.

So we are not to bill with 43235 anymore and if stop billing that way it would get paid solo? Do I use a modifier to state that difference in technique utilization?
 
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