Question EGD Capsule Placement

kayba89

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We have a patient who was seen for an EGD (43235) to place a PillCam (91110). Typically, we bill the EGD on the day that was done and the PillCam on the day the results were read. The complication we are running into is that the PillCam was interpreted the same day and the patient was found to have had poor prep resulting in a future CT scan for diagnosing. Now, how do we code for these to be payed correctly?

43235 with 91110-52? Do we need a modifier for the EGD as well?

All help appreciated :D
 

lcolborn

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And so , the Given capsule did not pass through or the poor prep you are referring to is the patient is not clean, that's why they are being scanned ? I would make sure that the EGD has a good diagnosis ( ex. Dysphagia etc ) . Some insurance carrier would not pay for the EGD, unless the patient have some kind of swallowing problem. The capsule can be ingested and pass through normally w/o an EGD.
I would try 43235 , 91110 -59, 52 and documentation explaining the reduction.
 

kayba89

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And so , the Given capsule did not pass through or the poor prep you are referring to is the patient is not clean, that's why they are being scanned ? I would make sure that the EGD has a good diagnosis ( ex. Dysphagia etc ) . Some insurance carrier would not pay for the EGD, unless the patient have some kind of swallowing problem. The capsule can be ingested and pass through normally w/o an EGD.
I would try 43235 , 91110 -59, 52 and documentation explaining the reduction.
Thank you :). That is what we were thinking, at least with the -52. The -59 makes sense and the part we were wondering about since they started to interpret the images the same day. And yes, the poor prep meant they couldn't see anything via the capsule once it was placed. The EGD does have a good diagnosis. Again, thank you!
 

CBScott24

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We have a patient who was seen for an EGD (43235) to place a PillCam (91110). Typically, we bill the EGD on the day that was done and the PillCam on the day the results were read. The complication we are running into is that the PillCam was interpreted the same day and the patient was found to have had poor prep resulting in a future CT scan for diagnosing. Now, how do we code for these to be payed correctly?

43235 with 91110-52? Do we need a modifier for the EGD as well?

All help appreciated :D
As stated by the other posted, depending on the insurance carrier, you should only be coding out the EGD CPT code if it was performed for any other diagnosis reason besides the Pill Cam placement. If the EGD was solely to place the pill cam, you should not code it. The Pill Cam should be billed with the -52 modifier since it did not visualize the whole area of the code description (the esophagus).
 
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