???? 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 used for the gastroesophageal reflux test. Coding precision during claim submission is vital for correct reimbursements. Therefore, healthcare organizations often outsource medical billing to streamline cash flow.
???? What is CPT Code 91035?
The American Medical Association (AMA) sets medical coding rules for reimbursement. CPT 91035 applies to a gastroesophageal reflux test, also known as the Bravo Capsule code. This procedure helps track acid reflux through pH monitoring. Proper documentation supports payer understanding.
???? CPT 91035 Modifier Details
Several modifiers are used with CPT 91035 under specific clinical circumstances. Let’s break down them:
- Modifier 26: Bills the professional component
- Modifier TC: Refers to the equipment and technician cost
- Modifier 52: Indicates reduced service.
- Modifier 53: Used if the procedure is discontinued
- Modifier 59: Used to prevent bundling errors
- Modifier 76: Applied when test is repeated on same day
- Modifier 77: Indicates separate provider involvement.
⚖️ Is CPT Code 91035 Related to CPT Code 00812?
No, they are more info not related.
CPT 91035 is used for reflux diagnosis, more info while CPT 00812 represents anesthesia services
???? Top CPT 91035 Coding Mistakes
1️⃣ Modifier Confusion
Incorrect modifier selection for CPT 91035, it could lead to billing rejections. Always verify the correct modifier before submission.
2️⃣ Inaccurate Documentation
Incomplete or incorrect details can lead to claim rejection. Ensure accuracy in every billing field, including patient info, procedure details, and modifiers
???? Conclusion
GERD is diagnosed through pH monitoring that measures acid exposure in the esophagus.
Providers bill under CPT Code 91035 to ensure correct payment. Correct modifier usage and accurate coding optimize the revenue cycle.