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EGD with Capule Placement

Lee Posted Wed 20th of March, 2013 16:08:49 PM

How do I bill an EGD with capsule endoscopy placement

SuperCoder Answered Thu 21st of March, 2013 15:43:35 PM

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.

In general, a physician needs to perform an EGD to evaluate the symptoms which are also prompting the use of a Bravo capsule. In order to place a Bravo capsule the physician needs to know the location of the lower esophageal sphincter or squamocolumnar junction. This is where it gets tricky.

When an endoscopy is performed to investigate symptoms then the endoscopy procedure will be billed on the date it was performed with the ICD-9 code representing the patient's symptoms. The CPT code might be 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]) or 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple), depending on the service. At the same session the physician might also decide to place a Bravo capsule using the measurements obtained during the endoscopy (billable with 91035, Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation). The date of service for the claim for the Bravo capsule will be when the recorder is retrieved 2-4 days later and the physician is sure that data was captured for analysis.

However, if the gastroenterologist performed an endoscopy recently (roughly within several months) to evaluate the symptoms at some date prior to Bravo placement, then it should not be necessary to repeat it just to get the location needed for the Bravo capsule placement. The second endoscopy would not be medically necessary and therefore not separately billable. You should include this in the Bravo claim.

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