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Thread: Pillcam code?

  1. #1

    Default Pillcam code?

    Promo: Code Books
    One of the doctors in my office asked me a question regarding how I would code for a pillcam if she only did the placement and another Dr in the office actually did the interpretation and report of the results. She wants to place it, but feels more comfortable having someone more experienced with the pillcam do the reading.

    The pillcam is going to be placed in the OR durring an EGD because the child is too young to swallow the capsule. This is a normal procedure and I normally just code 91110. When its done in the office setting I do not use a modifer 26, because the dr actually owns her own equipment.

    Im just wondering if there is a way to split this for the drs? Any insight would be great appreciated! Thank you so much!

  2. #2
    Join Date
    Apr 2007
    Location
    Charlotte, NC
    Posts
    534

    Default

    You can only code the EGD for the placement. Not 100% sure, but close to 90% sure, lol. Maybe 91110 with the TC modifier? In addition to the EGD for placement?

    The reading dr would code the 91110 with a 26 modifier on the date they read it.

  3. #3
    Join Date
    Apr 2007
    Location
    Atlanta Perimeter
    Posts
    59

    Default

    I agree with the 91110 with TC modifier together with the code for the EGD if the physician doing the placement owns the capsule.

    If the hospital owns the capsule then all the physician doing the placement can do is bill the EGD since another physician will be doing the reading.
    Elizabeth Escalante, CPC
    Operations Manager
    Atlanta Gastroenterology Associates

  4. #4

    Default Incomplete pillcam

    If you had an incomplete pillcam and medicare is the ins., mod.53 is denied? What mod.should we use these days? PLEASE HELP???
    Last edited by PamelaJ7; 03-21-2012 at 08:41 AM. Reason: INCORRECT SPELLING

  5. #5
    Join Date
    Apr 2007
    Location
    Longview, TX
    Posts
    31

    Default incomplete pillcam

    Per CPT guidelines, if the ileum is not visualized, append modifier 52. Medicare requires documentation to be sent with the claim. If you don't send the documentation and have to appeal, it takes another 8 to 10 weeks for redetermination.

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