Consider DOS while billing 43235 with 91035

While going about your routine gastroenterology coding work, you might run into various confusions. For instance, a reader enquired about which codes to use while billing a Bravo capsule placed during EGD. As far as my understanding goes, 91035 includes endoscopy. But then the answer given in the reader’s question was to bill 43235 and 91035. Can you throw some light on this?

What was not made clear in the simple answer provided was the billing dates for each code. Normally, a doctor needs to carry out an EGD to assess the symptoms which are prompting the use of a bravo capsule. In order to place a Bravo capsule the doctor needs to know the location of the lower esophageal sphincter or squamocolumnar junction. This is where it gets a bit intriguing.

When an endoscopy is carried out to investigate symptoms then the endoscopy procedure will be billed on the date it was carried out with the ICD-9 code representing the patient’s symptoms. The CPT code might be 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as apt; diagnostic, with or minus collection of specimen[s] by brushing or washing [separate procedure]) or 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple), depending on the service. At the same session the doctor might also decide to place a Bravo capsule using the measurements obtained during the endoscopy. The DOS for the claim for the Bravo capsule will be when the recorder is retrieved two-four days later and the doctor is sure that data was captured for analysis.

But then if the gastroenterologist carried out an endoscopy recently (approximately within several months) to assess the symptoms at some date prior to Bravo placement, then it should not be important to repeat it just to get the location required of the Bravo capsule placement. The secondary endoscopy would not be medically necessary and as such not separately billable. You should include this in the Bravo claim.

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