Payment for the new Bravo pH Monitoring System is so tenuous that many coders are preparing their appeals before they submit their claims but there are a few strategies that will help grease the reimbursement wheels.
Report the Test
The Bravo pH Monitoring System measures esophageal pH levels in patients who may have gastroesophageal reflux disease (GERD). The test confirms the diagnosis so the gastroenterologist can plan treatment.
The Bravo system involves the temporary intranasal or intraoral placement of a small capsule-size probe onto the wall of the esophagus, where it remains in place for up to 48 hours, says Scott Harris, product manager for Endonetics.
While in place, the Bravo capsule transmits data through radio frequency to a small, pager-size receiver that the patient wears. After the study period, the data stored in the receiver is uploaded to a computer for interpretation by the Bravo analysis software. The capsule is naturally passed through the patient's digestive tract within several days after the study period.
CPT contains two codes for acid reflux tests:
For tests that last less than 24 hours, use 91032. Because the Bravo system is a 48-hour test, assign prolonged reading code 91033, Harris says. For best reimbursement results, report 91033 when the test is completed and the gastroen-terologist analyzes the results.
If the physician conducts the test in a hospital setting or ambulatory surgical center, append modifier -26 (Professional component) to indicate that the doctor does not own the equipment and is billing for the interpretation only.
Bill Related Services
If the gastroenterologist performs a manometric study (91010-91020) in conjunction with the acid reflux test (91033), report both services in addition to any E/M service provided.
For instance, suppose a primary-care provider asks a gastroenterologist to consult on a patient with heartburn. The gastroenterologist examines the patient in the office, conducts an esophageal motility study, and inserts the capsule intranasally.
Report the manometry study and the consultation, and the acid reflux test two days later. Code the esophageal motility study 91010 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study). For the outpatient consultation, report 99241-99245 (Office consultation for a new or established patient). Append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the consultation code because the procedure and the E/M service are performed on the same day.
When the acid reflux results are analyzed, assign 91033. [...]