How To Use CPT Code 91034

CPT 91034 describes the procedure for a gastroesophageal reflux test, specifically involving the placement of a nasal catheter pH electrode to measure and record the backflow of acid from the stomach into the esophagus. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 91034?

CPT 91034 is used to describe a specific procedure known as a gastroesophageal reflux test. This test involves the placement of a pH electrode through the nasal passage and into the esophagus to measure and record the backflow of acid from the stomach. The provider then interprets the recorded data to assess the severity of the reflux.

2. Official Description

The official description of CPT code 91034 is: ‘Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode(s) placement, recording, analysis, and interpretation.’

3. Procedure

1. The provider prepares the patient for the procedure, ensuring appropriate anesthesia and patient comfort.
2. A slender catheter is inserted through one nostril, down the throat, and into the esophagus as the patient swallows.
3. The catheter contains a pH electrode that detects the acidity of the stomach contents.
4. The electrode is positioned just beyond the lower esophageal sphincter, which prevents acid reflux.
5. The sensor records each instance of acid reflux, sending the data to a recording device.
6. The patient is sent home with the catheter and recorder in place, instructed to continue their normal activities.
7. The provider removes the catheter the following day and connects the recorder to a computer for data analysis.

4. Qualifying circumstances

CPT 91034 is performed on patients suspected of having gastroesophageal reflux disease (GERD), a condition characterized by the backward flow of stomach acid into the esophagus. The test helps diagnose and assess the severity of GERD. It is important to note that the procedure requires a qualified provider and appropriate equipment to accurately measure and interpret the reflux data.

5. When to use CPT code 91034

CPT code 91034 should be used when a provider performs a gastroesophageal reflux test using a nasal catheter pH electrode for recording and analysis. This code is appropriate when the provider leaves the catheter in place, regardless of the duration of the test. It is important to ensure that the test is medically necessary and meets the specific criteria for reimbursement.

6. Documentation requirements

To support a claim for CPT 91034, the provider must document the following:

• Indication for the gastroesophageal reflux test
• Details of the procedure, including the placement of the nasal catheter pH electrode
• Date and duration of the test
• Recorded data and analysis of the reflux episodes
• Interpretation of the results
• Signature of the provider performing the test

7. Billing guidelines

When billing for CPT 91034, it is important to ensure that the procedure meets the specific criteria for reimbursement. The provider should use the appropriate modifiers, such as modifier 26 for the professional component or modifier TC for the technical component, if applicable. It is also important to follow any additional guidelines provided by the payer or coding guidelines.

8. Historical information

CPT 91034 was added to the Current Procedural Terminology system on January 1, 2005. There have been no updates or changes to the code since its addition.

9. Examples

1. A gastroenterologist performs a gastroesophageal reflux test using a nasal catheter pH electrode to assess the severity of acid reflux in a patient with suspected GERD.
2. A pediatrician conducts a gastroesophageal reflux test on an infant with symptoms of reflux, utilizing a nasal catheter pH electrode for recording and analysis.
3. An otolaryngologist performs a gastroesophageal reflux test on a patient with chronic throat irritation, using a nasal catheter pH electrode to measure and interpret the reflux episodes.
4. A gastroenterologist performs a gastroesophageal reflux test on a patient with persistent heartburn, utilizing a nasal catheter pH electrode for recording and analysis.
5. A pulmonologist conducts a gastroesophageal reflux test on a patient with respiratory symptoms, using a nasal catheter pH electrode to assess the potential impact of acid reflux on the lungs.
6. A family physician performs a gastroesophageal reflux test on a patient with atypical chest pain, utilizing a nasal catheter pH electrode for recording and analysis.
7. An otolaryngologist conducts a gastroesophageal reflux test on a patient with chronic cough, using a nasal catheter pH electrode to measure and interpret the reflux episodes.
8. A gastroenterologist performs a gastroesophageal reflux test on a patient with difficulty swallowing, utilizing a nasal catheter pH electrode for recording and analysis.
9. A pediatric gastroenterologist conducts a gastroesophageal reflux test on a child with recurrent vomiting, using a nasal catheter pH electrode to assess the presence of acid reflux.
10. An otolaryngologist performs a gastroesophageal reflux test on a patient with hoarseness, utilizing a nasal catheter pH electrode for recording and analysis.