How To Use CPT Code 91035

CPT 91035 describes the procedure for a gastroesophageal reflux test with mucosal attached telemetry pH electrode placement, recording, analysis, and interpretation. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 91035?

CPT 91035 is used to describe a specific procedure known as a gastroesophageal reflux test. This test is performed to determine the backflow of acid from the stomach into the esophagus. The procedure involves the placement of a mucosal attached telemetry pH electrode, which records and transmits data for analysis and interpretation by the healthcare provider.

2. Official Description

The official description of CPT code 91035 is: ‘Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis, and interpretation.’

3. Procedure

1. The healthcare provider prepares the patient for the procedure, ensuring they are appropriately prepped and anesthetized.
2. The provider activates the telemetry capsule and calibrates the pH buffer.
3. An endoscopy is performed to locate and diagnose the anatomical area for placement of the capsule.
4. The provider inserts the capsule delivery device through the mouth or nostril to place the capsule into the lumen of the esophagus, specifically above the lower esophageal sphincter.
5. The telemetry capsule transmits data to an externally placed data receiver.
6. The provider attaches the capsule and performs a compatibility test of the capsule and data receiver.
7. The patient is left with the attached capsule and receiver for 48 hours.
8. After 48 hours, the provider downloads the data from the receiver and interprets the findings.
9. The provider prepares a written report based on the data collected during the procedure.
10. The capsule passes out of the intestines through bowel movement after a few days.

4. Qualifying circumstances

CPT 91035 is performed on patients who require a gastroesophageal reflux test to determine the backflow of acid from the stomach into the esophagus. This test is typically used to diagnose conditions such as gastroesophageal reflux disease (GERD) and assess the severity of the condition. The procedure involves the placement of a mucosal attached telemetry pH electrode, which allows for accurate recording, analysis, and interpretation of the reflux test results.

5. When to use CPT code 91035

CPT code 91035 should be used when a healthcare provider performs a gastroesophageal reflux test with mucosal attached telemetry pH electrode placement, recording, analysis, and interpretation. This code is appropriate when the specific procedure described in the official description is performed.

6. Documentation requirements

To support a claim for CPT code 91035, the healthcare provider must document the following information:

• Patient’s medical history and symptoms indicating the need for a gastroesophageal reflux test
• Details of the procedure, including the placement of the mucosal attached telemetry pH electrode
• Date and duration of the procedure
• Results of the test, including any abnormalities or findings
• Interpretation of the data collected during the procedure
• Preparation of a written report based on the findings

7. Billing guidelines

When billing for CPT code 91035, ensure that the procedure described in the official description is performed. Use the appropriate modifiers if reporting only the professional or technical component of the service. It is important to follow the specific billing guidelines provided by the payer to ensure accurate reimbursement for the procedure.

8. Historical information

CPT code 91035 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 patient undergoes a gastroesophageal reflux test with mucosal attached telemetry pH electrode placement, recording, analysis, and interpretation to assess the severity of their GERD symptoms.
2. A healthcare provider performs a gastroesophageal reflux test on a patient with suspected acid reflux, using a mucosal attached telemetry pH electrode for accurate recording and interpretation of the test results.
3. During a gastroesophageal reflux test, a mucosal attached telemetry pH electrode is placed in the esophagus of a patient to monitor the backflow of acid from the stomach and provide data for analysis and interpretation.
4. A healthcare provider performs a gastroesophageal reflux test with mucosal attached telemetry pH electrode placement, recording, analysis, and interpretation to evaluate the effectiveness of a patient’s current treatment plan for GERD.
5. Using a mucosal attached telemetry pH electrode, a healthcare provider performs a gastroesophageal reflux test to determine the presence and severity of acid reflux in a patient.
6. A patient undergoes a gastroesophageal reflux test with mucosal attached telemetry pH electrode placement, recording, analysis, and interpretation to aid in the diagnosis of their chronic heartburn symptoms.
7. A healthcare provider performs a gastroesophageal reflux test on a patient with suspected GERD, utilizing a mucosal attached telemetry pH electrode for accurate recording and interpretation of the test results.
8. During a gastroesophageal reflux test, a mucosal attached telemetry pH electrode is placed in the esophagus of a patient to monitor the backflow of acid from the stomach and provide data for analysis and interpretation.
9. A healthcare provider performs a gastroesophageal reflux test with mucosal attached telemetry pH electrode placement, recording, analysis, and interpretation to evaluate the effectiveness of a patient’s current treatment plan for acid reflux.