Per the Centers for Medicare & Medicaid Services (CMS) Transmittal 2407, the place of service (POS) code for all physicians paid under the Medicare Physician Fee Schedule (MFPS) must match the setting in which the beneficiary receives the face-to-face service. Billable, non face-to-face services (such as when a physician interprets diagnostic test results) are billed to the POS in which the beneficiary received the technical portion of the service.
The reference can be found in Coding Edge Magazine May Issue ; Page 19.CMS instructs diagnostic testing interpretation to use the same POS as where the technical component was performed.
Prior to placement of a Bravo capsule, your gastroenterologist will generally need to perform an EGD. The purpose of the EGD is multiple as it helps your gastroenterologist assess the location of anatomical landmarks such as the lower esophageal sphincter or the squamocolumnar junction to help place the Bravo capsule. The procedure also helps in the assessment of the signs and symptoms that the patient is experiencing.
If the evaluation through EGD prompted the placement of the Bravo capsule, then the EGD procedure is billed on the date that it was placed. You will report it with 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).
If your gastroenterologist performs a biopsy during the endoscopy, you will need to report it with 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) with the billing date on the day it was performed. If the only reason to perform the EGD is to determine the location for a Bravo placement, then the endoscopic procedure is considered part of the Bravo CPT code and is not separately billable.
The Bravo capsule is read when it is retrieved after a period of about two to four days after it has been placed. You will need to report the Bravo capsule with 91035 (Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation) with the billing date on the day when it is read.
A modifier 26 (Professional component) is placed if your gastroenterologist is performing the reading (professional component) only. If you are claiming for both the technical and the professional component of the Bravo capsule placement, you will only bill with 91035.