???? Understanding CPT Code 91035 for GERD Diagnosis

Introduction:

To diagnose GERD effectively, providers perform acid level monitoring with telemetry pH electrode placement.
In medical billing, CPT Code 91035 is used for the gastroesophageal reflux test. Accurate coding during claim submission is vital for correct reimbursements. Therefore, healthcare organizations often partner with billing experts to streamline the revenue cycle.

???? What is CPT Code 91035?

The American Medical Association (AMA) created coding standards to simplify payments. CPT 91035 represents a gastroesophageal reflux test, get more info commonly referred to as the Bravo Capsule code. This procedure monitors acid pH via mucosal-attached telemetry electrodes. Proper documentation supports payer understanding.

???? Applicable Modifiers for CPT 91035

Several modifiers can accompany CPT 91035 under unique clinical circumstances. Let’s break down them:

• Modifier 26: Indicates the physician’s portion of service.


• Modifier TC: Covers the technical component


• Modifier 52: Applied when part of the procedure is omitted


• Modifier 53: Reports halted procedures.


• Modifier 59: Reports separate, non-overlapping procedures.


• Modifier 76: Indicates repeated service.


• Modifier 77: Reports repeat service by different provider

⚖️ Is CPT Code 91035 Related to CPT Code 00812?

No, website they are not related.
CPT 91035 is used for reflux diagnosis, while CPT 00812 represents anesthesia services

???? Billing Errors to Watch Out for in CPT 91035

1️⃣ Using the Wrong Modifier

When coders choose the wrong modifier for CPT 91035, the reimbursement can be delayed. Always verify the correct modifier before submission.

2️⃣ Inaccurate Documentation

Missing patient or provider information can result in denied payments. Ensure clarity in every billing field, including patient info, procedure details, and modifiers

???? Conclusion

GERD is diagnosed through pH monitoring that measures acid exposure in the esophagus.
Providers submit CPT 91035 to insurers to receive appropriate reimbursement. Correct modifier usage and accurate coding enhance financial performance.