DOS for 91038

[kmeagher]

I have gotten some conflicting answers on this, so I'm hoping some one can provide me with an authoritative reference for determining the DOS for 91038 when performed in the office. I thought it should be the date the probe is inserted, but my dr thinks it's the date it is removed (at home, by the pt). I have seen a few sources that say it should be the date the dr interprets the results. Any help would be much appreciated. TIA!

 

[CodingKing]

I'm trying to find a source other than Lab and radiology but the DOS is typically the date of the face to face encounter. Imagine if the patient lost their insurance the day after the test and they expected the day they were seen was to be the DOS.

 

[JenniferB7]

There is very little guidance out there to address your question. So, in this case, I fall back on CPT / payer precedence.

CPT code 91038 is for Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation; prolonged (greater than 1 hour, up to 24 hours). Until all components of the code (placement, recording, analysis & interpretation) have been met, the code is not billable. So, I would code the date the physician review/interprets the test as the DOS.

This is consistent with Medicare guidance for a similar type of code, CPT code 93224 for External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional. This code is similar in that it is a 24 hour monitoring code and includes the same components (recording, scanning, review/interpretation). Medicare LCD L34636 includes a billing and coding PDF (attached) which states that when billing CPT 93224: "Use the date of physician review as the date of service (DOS)."

Hope this helps!