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While you know for sure that you can report 91110 and 91111 for capsule study, but knowing just that is not enough to prevent your claims from being denied. We’ll tell you just when it is appropriate to report them and which modifiers to append.
Reporting a Repeat Procedure with 91110
Sometimes, your gastroenterologist would use a capsule study to image the intraluminal esophagus all the way through the ileum and reaching the colon. In this case, you should report 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report).
Let’s take an example. Patient comes in for a capsule endoscopy, but the capsule gets stuck in foodon hour five and visuals cannot be seen past the stomach. The gastroenterologist ends up repeating the procedure to see if she can see the small and large intestine.
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.
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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Don’t miss out on extra pay when global period resets.
Just because you routinely append modifiers to your claims doesn’t mean you’re filing correctly and getting the most appropriate pay. Brush up on your modifier know-how with these tips for three of the trickiest choices: modifiers 58, 78, and 79.
Selecting between these modifiers can be carrier-specific in some situations, says Jacqui Jones, office manager for Benjamin F. Balme, MD, PC in Klamath Falls, Ore.
Remember All Possible Uses for 58
The descriptor for modifier 58 seems self-explanatory: Staged or related procedure by the same physician during the postoperative period. Coders sometimes trip, however, when they forget that modifier 58 actually applies to subsequent procedures that fall into one of three categories:
Planned or anticipated (staged): A good example might be an infected hand that has to be debrided several times over the course of a couple of weeks. You won’t use a modifier on the first procedure, but will add modifier 58 on the subsequent procedures.
More extensive than the original procedure: The physician manipulates a patient’s ulnar fracture. An x-ray at the follow-up appointment shows that the reduction failed, so the physician completes pinning or an open reduction with internal fixation (ORIF). Code the procedure as needed (with 25545, Open treatment of ulnar shaft fracture, includes internal fixation, when performed, for example) and append modifier 58.
Therapy or treatment following a surgical or diagnostic procedure: This could apply to a soft tissue biopsy followed at a later date by malignant tumor excision.
You’ll only append modifier 58 to the second procedure if it occurs during the first procedure’s global period. The date of the second procedure resets the global period. You should expect 100 percent reimbursement for procedures you file with modifier 58.
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