???? 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 applies to the gastroesophageal reflux test. Accurate coding during claim submission is essential for correct reimbursements. Therefore, healthcare organizations often delegate billing tasks to streamline the revenue cycle.

???? Definition and Explanation of CPT Code 91035

The American Medical Association (AMA) sets medical coding rules for reimbursement. CPT 91035 represents a gastroesophageal reflux test, also known as the Bravo Capsule code. This procedure uses Bravo Capsule placement to record esophageal acid exposure. Proper documentation supports payer understanding.

???? Applicable Modifiers for CPT 91035

Multiple modifiers may be appended to CPT 91035 under unique clinical circumstances. Let’s go through them:

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


• Modifier TC: Reports the procedural performance aspect.


• Modifier 52: Indicates reduced service.


• Modifier 53: Applied when treatment stops for patient safety


• Modifier 59: Used to prevent bundling errors


• Modifier 76: Applied when test is repeated on same day


• Modifier 77: Indicates separate provider involvement.

⚖️ Difference Between CPT 91035 and 00812

These codes refer to different services.
CPT 91035 reports GERD testing, while read more CPT 00812 is assigned for colonoscopy anesthesia billing.

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

1️⃣ Incorrect Modifier Usage

Incorrect modifier selection for CPT 91035, the reimbursement can be delayed. Always verify the correct modifier before submission.

2️⃣ Poor Claim Documentation

Missing patient or provider information can result in denied payments. Ensure accuracy in every billing field, including documentation of service level

???? Key Takeaway

Gastroesophageal reflux disease diagnosis involves analyzing acid backflow click here with pH monitoring.
Providers bill under CPT Code 91035 to receive appropriate reimbursement. Correct modifier usage and precise billing enhance financial performance.