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billing for Bravo

  1. #1
    Default billing for Bravo
    Medical Coding Books
    In the past when billing for the 91035, Bravo PH test, we have always billed with a -26 modifier. This indicates that we are billing for the professional component. (physician's interpretation) The hospital bills with a -TC modifier, which indicates that they are billing for the technical component. (owning the equipment) That way the insurance company knows they have to split the fee between the hospital and our physician.

    So what we are wondering is - if we are providing the service, and own the equipment, are we correct in assuming we would bill the 91035 without modifiers? I believe that we would then get reimbursed 100% of the allowed amount.

    We are also wondering, for those of you with ambulatory surgery centers and who own the Bravo equipment, how are you billing for the procedure? Did you have your ASC purchase the equipment and are you billing it as 91035 -26 for the physician, and 91035-TC for your ASC? Or did you have your medical office purchase the equipment and are you billing just the 91035 in the office setting?
    Last edited by Colliemom; 06-05-2009 at 01:30 PM.

  2. #2
    Greeley, Colorado
    We have an ASC. For the docs, we code 91035 and no modifiers because they purchase the bravo capsule. The capsule is not separately billable because it is inclusive to 91035. It is supposed to be billed on the date of interpretation. Our docs place it after/during an EGD, no code is reported by the ASC for the bravo, only the EGD codes.
    Lisa Bledsoe, CPC, CPMA

  3. Default PH Testing
    I agree & would use 91035 for the Bravo pH testing. We use 91034 for most of the pH testing we do. (24 hr monitoring). The Dr. normally determines during an EGD that the patient needs pH testing.

    The hospital quit providing the service, due to reimbursement. The reimbursement varies by carrier and probably records are either requested or sent w/an appeal.

    We perform endoscopy procedures (endoscopy suite), lactose tolerance testing & capsule endoscopies (WCE) in our office.
    Last edited by TNavarre; 06-09-2009 at 02:51 PM.

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