GASTROENTEROLOGY - Sandhill Scientific
GASTROENTEROLOGY - Sandhill Scientific
GASTROENTEROLOGY - Sandhill Scientific
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December 2006<br />
<strong>GASTROENTEROLOGY</strong><br />
DIAGNOSTIC CODING EXAMPLES<br />
Catheter based pH Monitoring<br />
Catheter based Impedance/pH Monitoring<br />
Esophageal Manometry<br />
Esophageal Impedance Manometry<br />
Anorectal Manometry<br />
ERCP with Sphincter of Oddi Manometry<br />
Biofeedback<br />
SANDHILL<br />
SCIENTIFIC ®<br />
High Definition G.I. Diagnostics
<strong>Sandhill</strong> <strong>Scientific</strong> has compiled this coding information for your convenience. It is always the<br />
provider’s responsibility to determine coverage and submit appropriate codes, modifiers and charges<br />
for the services that were rendered. Contact your local carrier/payor for interpretation or appropriate<br />
coverage and coding polices. For unapproved uses, consult with your local carrier/payor before seeking<br />
reimbursement for use of a product that may be inconsistent with or not expressly specified in the FDA<br />
cleared or approved labeling (manual). Some payors may have policies that make it inappropriate to<br />
submit claims for such items or related services.<br />
The staff at <strong>Sandhill</strong> <strong>Scientific</strong> is available to respond to your general coding questions with respect to<br />
the contents of this pamphlet. Call toll free at 1-800-468-4556<br />
Contents<br />
Page<br />
Catheter based pH Monitoring 3<br />
Catheter based Impedance/pH Monitoring 4<br />
Esophageal Manometry 5<br />
Esophageal Impedance Manometry 6<br />
Anorectal Manometry 7<br />
ERCP with Sphincter of Oddi Manometry 8<br />
Biofeedback 9<br />
Modifiers 10<br />
Footnotes used throughout are as follows:<br />
1. CPT is a registered trademark of the American Medical Association. Current Procedural Terminology<br />
(CPT) is copyright 2004 of the American Medical Association.<br />
2. Medicare Fee Schedule derived from https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp?locality=CA<br />
3. The examples of ICD-9-CM Diagnosis Codes are found in the PMIC ICD-9-CM 2005.
Catheter based pH Monitoring<br />
Catheter based pH Monitoring Examples of ICD-9-CM Diagnostic Codes<br />
Esophagitis, unspecified 530.10<br />
Esophagitis, reflux 530.11<br />
Esophagitis, other 530.19<br />
Ulcer of esophagus without bleeding 530.20<br />
Ulcer of esophagus with bleeding 530.21<br />
Dyskinesia / spasm of esophagus 530.5<br />
Gastrointestinal reflux (GERD) 530.81<br />
Barrett’s Esophagus 530.85<br />
Persistent vomiting 536.2<br />
Dyspepsia and other specified disorders of function of stomach 536.8<br />
Diaphragmatic hernia 553.3<br />
Chest pain 786.5<br />
Chest pain, unspecified 786.50<br />
Heartburn 787.1<br />
Dysphagia 787.2<br />
Catheter based pH Monitoring: CPT Codes<br />
CPT Code Code Description Medicare Fee Schedule<br />
91034 Esophagus, gastroesophageal reflux test; with nasal catheter $240 - $400<br />
pH electrode(s) placement, recording, analysis and interpretation<br />
Catheter based pH Monitoring: Ambulatory Payment Classification (APC) for Medicare<br />
CPT Code Map to APC APC Description 2005 Base Payment<br />
91034 0361 Level II Alimentary Tests $207
Catheter based Impedance/pH Monitoring<br />
Catheter based Impedance/pH Monitoring Examples of ICD-9-CM Diagnostic Codes<br />
Esophagitis, unspecified 530.10<br />
Esophagitis, reflux 530.11<br />
Esophagitis, other 530.19<br />
Ulcer of esophagus without bleeding 530.20<br />
Ulcer of esophagus with bleeding 530.21<br />
Dyskinesia / spasm of esophagus 530.5<br />
Gastrointestinal reflux (GERD) 530.81<br />
Barrett’s Esophagus 530.85<br />
Persistent vomiting 536.2<br />
Dyspepsia and other specified disorders of function of stomach 536.8<br />
Diaphragmatic hernia 553.3<br />
Chest pain 786.5<br />
Chest pain, unspecified 786.50<br />
Heartburn 787.1<br />
Dysphagia 787.2<br />
Catheter based Impedance/pH Monitoring: CPT Codes<br />
CPT Code Code Description Medicare Fee Schedule<br />
91034 Esophagus, gastroesophageal reflux test; $240 - $400<br />
with nasal catheter pH electrode(s) placement,<br />
recording, analysis and interpretation<br />
91038 Esophageal function test, gastroesophageal $114 - $178<br />
reflux test with nasal catheter intraluminal<br />
impedance electrode(s) placement, recording,<br />
analysis and interpretation; prolonged<br />
(greater than 1 hour, up to 24 hours)<br />
Catheter based Impedance/pH Monitoring: Ambulatory Payment Classification (APC) for Medicare<br />
CPT Code Map to APC APC Description 2005 Base Payment<br />
91034 0361 Level II Alimentary Tests $207<br />
91038 0361 Level II Alimentary Tests $207
Esophageal Manometry<br />
Esophageal Manometry Examples of ICD-9-CM Diagnostic Codes<br />
Achalasia and cardiospasm 530.0<br />
Dyskinesia / spasm of esophagus 530.5<br />
Diverticulum of esophagus, acquired 530.6<br />
Esophagitis, unspecified 530.10<br />
Esophagitis, reflux 530.11<br />
Esophagitis, other 530.19<br />
Stricture and stenosis of esophagus 530.3<br />
Gastroesophageal reflux (GERD) 530.81<br />
Diaphragmatic hernia 553.3<br />
Scleroderma (systemic sclerosis) 710.1<br />
Feeding difficulties and mismanagement 783.3<br />
Chest pain, unspecified 786.50<br />
Heartburn 787.1<br />
Dysphagia 787.2<br />
Other symptoms involving digestive system 787.9<br />
Esophageal Manometry: CPT Codes<br />
CPT Code Code Description Medicare Fee Schedule<br />
91010 Esophageal motility (manometric $189 - $277<br />
study of the esophagus and/or<br />
gastroesophageal junction) study;<br />
Esophageal Manometry: Ambulatory Payment Classification (APC) for Medicare<br />
CPT Code Map to APC APC Description 2005 Base Payment<br />
91010 0361 Level II Alimentary Tests $207
Esophageal Impedance Manometry<br />
Esophageal Impedance Manometry: Examples of ICD-9-CM Diagnostic Codes<br />
Achalasia and cardiospasm 530.0<br />
Dyskinesia / spasm of esophagus 530.5<br />
Diverticulum of esophagus, acquired 530.6<br />
Esophagitis, unspecified 530.10<br />
Esophagitis, reflux 530.11<br />
Esophagitis, other 530.19<br />
Stricture and stenosis of esophagus 530.3<br />
Gastroesophageal reflux (GERD) 530.81<br />
Diaphragmatic hernia 553.3<br />
Scleroderma (systemic sclerosis) 710.1<br />
Feeding difficulties and mismanagement 783.3<br />
Chest pain, unspecified 786.50<br />
Heartburn 787.1<br />
Dysphagia 787.2<br />
Other symptoms involving digestive system 787.9<br />
Esophageal Impedance Manometry: CPT Codes<br />
CPT Code Code Description Medicare Fee Schedule<br />
91010 Esophageal motility (manometric $189 - $277<br />
study of the esophagus and/or<br />
gastroesophageal junction) study;<br />
91037 Esophageal function test, gastroesophageal $131 - $214<br />
reflux test with nasal catheter intraluminal<br />
impedance electrode(s) placement, recording,<br />
analysis and interpretation;<br />
Esophageal Impedance Manometry: Ambulatory Payment Classification (APC) for Medicare<br />
CPT Code Map to APC APC Description 2005 Base Payment<br />
91010 0361 Level II Alimentary Tests $207<br />
91037 0361 Level II Alimentary Tests $207
Anorectal Manometry<br />
Anorectal Manometry: Examples of ICD-9-CM Diagnostic Codes<br />
Constipation, slow transit 564.01<br />
Constipation, outlet dysfunction 564.02<br />
Anal spasm / proctalgia fugax 564.6<br />
Megacolon, other than Hirschsprung’s 564.7<br />
Neurogenic bowel 564.81<br />
Other functional disorders of intestine 564.89<br />
Anal fissure / nontraumatic 565.0<br />
Rectal prolapse 569.1<br />
Stenosis of rectum and anus 569.2<br />
Anal or rectal pain 569.42<br />
Hirschsprun’s Disease or megacolon (congenital) 751.3<br />
Incontinence of feces 787.6<br />
Anorectal Manometry: CPT Codes<br />
CPT Code Code Description Medicare Fee Schedule<br />
91120 Rectal sensation, tone, and compliance $385 - $600<br />
test (ie, response to graded balloon distention)<br />
91122 Anorectal Manometry $231 - $334<br />
Anorectal Manometry: Ambulatory Payment Classification (APC) for Medicare<br />
CPT Code Map to APC APC Description 2005 Base Payment<br />
91120 0156 Level II Urinary and Anal Procedures $141<br />
91122 0156 Level II Urinary and Anal Procedures $141
ERCP with Sphincter of Oddi Manometry<br />
ERCP with Sphincter of Oddi Manometry: Examples of ICD-9-CM Diagnostic Codes<br />
Cholangitis 576.1<br />
Obstruction of bile duct 576.2<br />
Spasm of sphincter of Oddi 576.5<br />
Other specified disorders of biliary tract 576.8<br />
Acute pancreatitis 577.0<br />
Chronic pancreatitis 577.1<br />
Cyst and pseudocyst of pancreas 577.2<br />
Other specified diseases of pancreas 577.8<br />
Anomalies of pancreas 751.7<br />
ERCP with Sphincter of Oddi Manometry: CPT Codes<br />
CPT Code Code Description Medicare Fee Schedule<br />
43263 Endoscopic retrograde cholangio- $401<br />
pancreatography (ERCP); with pressure<br />
measurement of sphincter of Oddi<br />
(pancreatic duct of common bile duct)<br />
ERCP with Sphincter of Oddi: Ambulatory Payment Classification (APC) for Medicare<br />
CPT Code Map to APC APC Description 2005 Base Payment<br />
43263 0151 Endoscopic Retrograde $1,067<br />
Cholangio-Pancreatic (ERCP)
Biofeedback<br />
Biofeedback: Examples of ICD-9-CM Diagnostic Codes<br />
Constipation, outlet dysfunction 564.02<br />
Anal spasm / proctalgia fugax 564.6<br />
Incontinence of feces 787.6<br />
Biofeedback: CPT Codes<br />
CPT Code Code Description Medicare Fee Schedule<br />
90911 Biofeedback training; perineal muscles, $95<br />
anorectal or urethral sphincter, including<br />
EMG and/or manometry<br />
99211 - Office or other patient visit $22 - $120<br />
99215<br />
Biofeedback: Ambulatory Payment Classification (APC) for Medicare<br />
CPT Code Map to APC APC Description 2005 Base Payment<br />
90911 0321 Biofeedback and Other Training $81
Modifiers<br />
Modifier Definition AMA Guidelines<br />
-22<br />
Unusual Procedural Services<br />
When the service(s) provided is<br />
greater than that usually required<br />
This modifier should be used ONLY<br />
when additional work factors<br />
for the listed procedure.<br />
requiring the physician’s technical<br />
skill involve significantly increasing<br />
physician work, time and complexity<br />
of the procedure normally performed<br />
-26<br />
Professional Component<br />
Certain procedures are a<br />
combination of a physician<br />
component and a technical<br />
component.<br />
CPT coding does provide modifier<br />
26 for separately reporting the<br />
professional component of a<br />
procedure or service. Modifier 26<br />
is used to identify the professional<br />
component of a service or procedure<br />
that is being reported separately.<br />
TC<br />
Technical Component<br />
Under certain circumstances,<br />
a charge may be made for the<br />
technical component alone. Under<br />
those circumstances the technical<br />
component charge is identified by<br />
adding modifier “TC” to the usual<br />
procedure number.<br />
For interpretation, add the modifier<br />
-26.<br />
Technical component charges are<br />
institutional charges and not billed<br />
separately by physicians. The only<br />
way to add the “TC” modifier is if<br />
the physician owns the equipment<br />
– other requirements may apply as<br />
well.<br />
Note: This coding list is not all-inclusive and is not intended to represent all coding options. Coding of additional diagnoses and<br />
procedure codes, just as for principal diagnosis and procedure coding, is dependent on the documentation in the patient’s medical<br />
record.<br />
Disclaimer: This information is provided by <strong>Sandhill</strong> <strong>Scientific</strong>, Inc. as a guide for coding procedures and services involving Esophageal<br />
Manometry, Esophageal Impedance/Manometry, Catheter based pH, Catheter based Impedance/pH, Anorectal Manometry, Sphincter<br />
of Oddi and Biofeedback. It is not intended to increase of maximize reimbursement by any payor. This information is intended to assist<br />
providers in accurately obtaining coverage and reimbursement for their health care services. Providers assume full responsibility for<br />
all reimbursement decisions or actions. We strongly suggest that you consult your payer organizations with regards to local coverage,<br />
bundling and reimbursement policies.<br />
1. Coding with Modifiers, A Guide to Correct CPT and HCPCS Level II Modifier Usage 2nd Edition, Deborah J. Grider;<br />
Copyright 2006 by the American Medical Association.<br />
2. Current Procedural Terminology (CPT) 2007, Standard Edition; Copyright 2006, American Medical Association.<br />
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SANDHILL<br />
SCIENTIFIC ®<br />
High Definition G.I. Diagnostics<br />
9150 Commerce Center Circle<br />
Suite 500<br />
Highlands Ranch, Colorado 80129<br />
USA<br />
800.468.4556<br />
303.470.7020<br />
www.sandhillsci.com<br />
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