Recently, in a particular volume of a gastroenterology coding alert, a reader enquired about which codes to use when billing a Bravo capsule placed during EGD. To my knowledge, 91035 includes endoscopy. But then the answer provided in the question was to bill 43235 and 91035. Can you throw some light on this?
Answer: Well, what was not made clear in the simple answer provided was the billing dates for each code. Normally, a physician needs to carry out an EGD to assess the symptoms which are also prompting the use of a Bravo capsule. To place a Bravo capsule, the doctor needs to be aware of the location of the lower esophageal sphincter or squamocolumnar junction. You should be careful here as this is where it gets dicey.
When an endoscopy is performed to look into symptoms then the endoscopy procedure will be billed on the date it was performed with the ICD-9 code representing the patient's symptoms. Depending on the service, the CPT code might be 43235 or 43239. During the same session, the doctor might also decide to place a Bravo capsule using the measurements got during the endoscopy (billable with 91035). The date of service for the claim for the Bravo capsule will be when the recorder is retrieved two-four days later and the doctor is sure that data was captured for analysis.
But then, if the gastroenterologist carried out an endoscopy recently (roughly within several months) to assess the symptoms at some date prior to Bravo placement, then it shouldn't 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 as such not separately billable. You should make it a point to include this in the Bravo claim.
Answer: Well, what was not made clear in the simple answer provided was the billing dates for each code. Normally, a physician needs to carry out an EGD to assess the symptoms which are also prompting the use of a Bravo capsule. To place a Bravo capsule, the doctor needs to be aware of the location of the lower esophageal sphincter or squamocolumnar junction. You should be careful here as this is where it gets dicey.
When an endoscopy is performed to look into symptoms then the endoscopy procedure will be billed on the date it was performed with the ICD-9 code representing the patient's symptoms. Depending on the service, the CPT code might be 43235 or 43239. During the same session, the doctor might also decide to place a Bravo capsule using the measurements got during the endoscopy (billable with 91035). The date of service for the claim for the Bravo capsule will be when the recorder is retrieved two-four days later and the doctor is sure that data was captured for analysis.
But then, if the gastroenterologist carried out an endoscopy recently (roughly within several months) to assess the symptoms at some date prior to Bravo placement, then it shouldn't 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 as such not separately billable. You should make it a point to include this in the Bravo claim.
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