How To Use CPT Code 91040

CPT 91040 describes the procedure for an esophageal balloon distension study, which is used to determine the cause of a patient’s chest pain. 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 91040?

CPT 91040 can be used to describe the esophageal balloon distension study, a diagnostic procedure performed by a healthcare provider to determine whether a patient’s chest pain is caused by esophageal or cardiac issues. This procedure involves the insertion of a balloon dilator through the mouth and into the esophagus, followed by inflation of the balloon at various points along the esophagus to provoke a pain response. The provider records the patient’s pain response using a pressure recording device.

2. Official Description

The official description of CPT code 91040 is: ‘Esophageal balloon distension study, diagnostic, with provocation when performed.’

3. Procedure

1. The healthcare provider prepares the patient and administers anesthesia.
2. The provider inserts a balloon dilator through the patient’s mouth and into the esophagus.
3. The dilator is advanced to the lower esophageal sphincter.
4. The provider inflates the balloon multiple times at different points along the esophagus to provoke a pain response.
5. The pain response is recorded using a pressure recording device.
6. If necessary, the provider may administer a chemical agent to elicit a reaction in the esophagus.
7. If the esophagus contracts and causes chest pain, it indicates that the likely cause of the patient’s chest pain is esophageal and not cardiac.

4. Qualifying circumstances

CPT 91040 is performed on patients who experience chest pain and need to determine whether the cause is esophageal or cardiac. The procedure is typically performed by a healthcare provider who is trained and qualified to perform esophageal balloon distension studies. The provider may use a chemical agent to provoke a pain response in the esophagus. It is important to note that CPT 91040 should not be reported more than once per session.

5. When to use CPT code 91040

CPT code 91040 should be used when a healthcare provider performs an esophageal balloon distension study with provocation to diagnose the cause of a patient’s chest pain. It is important to ensure that the procedure is performed according to the official description and that the necessary qualifying circumstances are met.

6. Documentation requirements

To support a claim for CPT 91040, the healthcare provider must document the following information:

• Patient’s symptoms and the need for the esophageal balloon distension study
• Details of the procedure, including the use of a balloon dilator and any chemical agents
• Date and duration of the procedure
• Record of the pain response using a pressure recording device
• Any additional relevant information or findings

7. Billing guidelines

When billing for CPT 91040, it is important to ensure that the procedure is performed according to the official description. If reporting only the professional component, append modifier 26 to the code. If reporting only the technical component, append modifier TC to the code, unless the hospital provided the technical component. Do not append modifiers if reporting a global service where one provider renders both the professional and technical components. It is also important to follow any additional billing guidelines provided by the payer.

8. Historical information

CPT 91040 was added to the Current Procedural Terminology system on January 1, 2005. The code was later changed on January 1, 2016, to include the term “provocation” in the description.

9. Examples

1. A healthcare provider performs an esophageal balloon distension study with provocation to determine the cause of a patient’s chest pain.
2. During the procedure, the provider inflates the balloon at various points along the esophagus and records the patient’s pain response.
3. The patient experiences chest pain when the esophagus contracts, indicating that the cause of the chest pain is esophageal.
4. The provider documents the findings and discusses the results with the patient.
5. Another healthcare provider performs an esophageal balloon distension study with provocation and administers a chemical agent to elicit a reaction in the esophagus.
6. The patient experiences chest pain in response to the provocation, confirming that the cause of the chest pain is esophageal.
7. The provider records the pain response and discusses the findings with the patient.
8. A different healthcare provider performs an esophageal balloon distension study without provocation to evaluate a patient’s chest pain.
9. The patient does not experience chest pain during the procedure, suggesting that the cause of the chest pain may be cardiac.
10. The provider documents the absence of a pain response and discusses further diagnostic options with the patient.