???? 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 billed for the gastroesophageal reflux test. Accurate coding during claim submission is vital for correct reimbursements. Therefore, providers often outsource medical billing to streamline financial performance.

???? What is 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

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

• Modifier 26: Used for interpretation and report only


• Modifier TC: Refers to the equipment and technician cost


• Modifier 52: Used when service is partially reduced


• Modifier 53: Used if the procedure is discontinued


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


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


• Modifier 77: Reports repeat service by different provider

⚖️ Is CPT Code 91035 Related to CPT Code 00812?

CPT 91035 and CPT 00812 represent unrelated get more info procedures.
CPT 91035 is used for reflux diagnosis, while CPT 00812 refers to anesthesia during colonoscopy

???? Common Mistakes to Avoid When Billing CPT Code 91035

1️⃣ Modifier Confusion

Incorrect modifier selection for CPT 91035, the reimbursement can be delayed. Always double-check the CPT pairing before submission.

2️⃣ Inaccurate Documentation

Missing patient or provider information can cause reimbursement delays. Ensure clarity in every billing field, including patient info, procedure details, and modifiers

???? Key Takeaway

Gastroesophageal reflux read more disease diagnosis involves analyzing acid backflow with pH monitoring.
Providers use CPT 91035 for reimbursement to ensure correct payment. Correct modifier usage and precise billing optimize the revenue cycle.