G.I. Diagnostic Reimbursement Codes 2011 - Sandhill Scientific
G.I. Diagnostic Reimbursement Codes 2011 - Sandhill Scientific
G.I. Diagnostic Reimbursement Codes 2011 - Sandhill Scientific
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G.I. <strong>Diagnostic</strong> <strong>Reimbursement</strong> <strong>Codes</strong> <strong>2011</strong><br />
Esophageal Motility<br />
CPT<br />
Description<br />
Hospital Outpatient<br />
APC<br />
91010 Esophageal motility (manometric study of the esophagus and/or gastroesophageal<br />
junction) study with interpretation and report; 2 dimensional study<br />
91037 Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal<br />
impedance electrode(s) placement, recording, analysis and interpretation<br />
91013 With stimulant or perfusion during 2 dimensional data study (eg: stimulant or acid or<br />
alkali perfusion). List separately in addition to code for primary procedure.<br />
0361<br />
0361<br />
N/A<br />
0240T<br />
Esophageal motility (manometric study of the esophagus and/or gastroesophageal<br />
(Category junction) study with interpretation and report; with 3 dimensional high resolution N/A<br />
3 Code*) esophageal pressure topography (Do not report 0240T in conjunction with 91010)<br />
0241T<br />
With stimulation or perfusion during 3-dimensional high resolution esophageal<br />
(Category pressure topography study, (eg: stimulant, acid or alkali perfusion) N/A<br />
3 Code*) (List separately in addition to code for primary procedure)<br />
(Use in conjunction with 0240T. Do not use in conjunction with 91010.)<br />
*Category 3 code is a temporary code for emerging technology. It is<br />
crucial in evaluating the health care delivery and its impact on clinical<br />
efficacy and outcomes.<br />
Note: If using 0240T with the <strong>Sandhill</strong> HRiM probe, the Chicago<br />
Classification, specifically DCI must be measured as this is a 3<br />
dimensional calculation.
Esophageal Reflux Testing<br />
Hospital Outpatient<br />
CPT Description APC<br />
91034 Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode(s) placement,<br />
recording, analysis and interpretation (Do not use in conjunction with 91038)<br />
91038 Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal<br />
impedance electrode(s) placement, recording, analysis and interpretation; prolonged<br />
(greater than 1 hour, up to 24 hours) (Do not use in conjuction with 91034)<br />
0361<br />
0361<br />
Anorectal<br />
Hospital Outpatient<br />
CPT Description APC<br />
91122 Anorectal Manometry (Do not use in conjunction with 91117) 0164<br />
91120 Rectal sensation, tone, and compliance test (ie, response to graded balloon distention)<br />
(Do not use in conjunction with 91117)<br />
90911 Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG<br />
and/or manometry<br />
95900 Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without<br />
F-wave study (modifier 51 exempt)<br />
51797 Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal)<br />
(List separately in addition to code for primary procedure)<br />
0126<br />
0126<br />
N/A<br />
N/A<br />
51784 Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique N/A
Endoscopy<br />
Hospital Outpatient<br />
CPT Description APC<br />
43200 Esophagoscopy rigid or flexible with or without the collection of specimens by brushing or washing 0141<br />
43235 Upper Gastrointestinal Endoscopy: including esophagus, stomach, and whether duodenum and/or<br />
jejunum as appropriate; diagnostic, with or without collection of specimens by brushing or washing<br />
0141<br />
Other<br />
CPT<br />
Description<br />
43263 Endoscopic retrograde cholangiopancreatography (ERCP); with pressure measurement of sphincter<br />
of Oddi (pancreatic duct or common bile duct)<br />
91117 Colon motility (manometric) study, minimum 6 hours* continuous recording (including provocation<br />
tests, eg, meal, intracolonic balloon distension, pharmacologic agents, if performed), with<br />
interpretation and report<br />
91022 Duodenal motility (manometric) study<br />
91020 Gastric Motility (manometric) Studies<br />
91132 Electrogastrography, diagnostic, transcutaneous<br />
91133 Electrogastrography, diagnostic, transcutaneous; with provocative testing<br />
* The key to this code is that the test MUST consist of a minimum of 6 hours of study data.
<strong>Reimbursement</strong> Primer<br />
Coverage + Coding + Payment = <strong>Reimbursement</strong><br />
Coverage - The terms and conditions set by payers (insurers) that specify if a product/procedure<br />
will be paid and under what circumstances it will be paid. Location of service is one aspect that<br />
affects coverage.<br />
Primary Locations of Service<br />
Hospital Outpatient<br />
Facility<br />
ASC<br />
Hospital Inpatient<br />
Hospital service w/o admittance i.e. 24hr stay<br />
Coding - CPT and APC codes are most applicable to reflux and motility testing. Procedure trays used in testing may be reimbursable<br />
using appropriate HPCPS codes. Appropriate ICD-9 diagnostic codes are also required for reimbursement.<br />
Payment - Actual payment is dependent on geographic location and payer. Medicare policy is used as a guide by private insurers. Private insurers may<br />
reimburse less or more than Medicare. Providers that serve a large percentage of an insurer’s patient population may negotiate more favorable terms.<br />
Disclaimer<br />
Health economic and reimbursement information provided by <strong>Sandhill</strong> <strong>Scientific</strong> is gathered from thirdparty<br />
sources and is subject to change without notice as a result of complex and frequently changing laws,<br />
regulations, rules and policies. This information is presented for illustrative purposes only and does not<br />
constitute reimbursement or legal advice. <strong>Sandhill</strong> <strong>Scientific</strong> encourages providers to submit accurate and<br />
appropriate claims for services. It is always the provider’s responsibility to determine medical necessity,<br />
the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for<br />
services that are rendered. <strong>Sandhill</strong> <strong>Scientific</strong> recommends that you consult with your payers, reimbursement<br />
specialists and/or legal counsel regarding coding, coverage and reimbursement matters.<br />
<strong>Sandhill</strong> <strong>Scientific</strong>, Inc • 9150 Commerce Center Circle, #500<br />
Highlands Ranch, CO 80129 USA 800.468.4556 • 303.470.7020<br />
Fax: 303.470.2975 • www.sandhillsci.com<br />
©COPYRIGHT <strong>2011</strong> SANDHILL SCIENTIFIC PRINTED IN THE U.S.A. PL-10-003, Rev 3.0
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