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Capsule endoscopy 91110

Lisa Posted Fri 29th of June, 2012 14:36:30 PM

How would you code 91110, when the capsule did not leave stomack? With mod. 52? Provider is planning to repeat the procedure by placing the capsule in duodenum endoscopically the second time.

SuperCoder Answered Fri 29th of June, 2012 21:21:36 PM

First, you would code 91110 and then attach modifier 53 (Discontinued procedure) to indicate that the physician repeated the procedure. If the physician decides not to repeat the procedure, you should append modifier 52 (Reduced services) to reflect that the capsule imaged the patient's anatomy until it became lodged in the food.

Tip: If you plan on repeating a capsule study due to technical problems, it is a good idea to pre-authorize payment for the second study with the carrier. You may need to provide records of the incomplete study.

CPT 91110's descriptor clearly states the evaluation is from the esophagus to the ileum. The only time this won't be true is when the gastroenterologist places the pill cam endoscopically for the study, says Joel V. Brill, MD, AGAF, chief medical officer at Predictive Health LLC in Phoenix. Again in this case, you should attach modifier 52 to 91110.

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