???? 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 essential for correct reimbursements. Therefore, healthcare organizations often outsource medical billing to streamline financial performance.
???? Understanding CPT 91035
The American Medical Association (AMA) establishes guidelines for billing accuracy. CPT 91035 represents a gastroesophageal reflux test, also known as the more info Bravo Capsule code. This procedure monitors acid pH via mucosal-attached telemetry electrodes. Proper documentation supports payer understanding.
???? Applicable Modifiers for CPT 91035
Multiple modifiers are used with CPT 91035 under different clinical circumstances. Let’s review them:
- Modifier 26: Bills the professional component
- Modifier TC: Covers the technical component
- Modifier 52: Used when service is partially reduced
- Modifier 53: Used if the procedure is discontinued
- Modifier 59: Indicates a distinct procedure performed the same day
- Modifier 76: Shows repeat procedure by same provider
- Modifier 77: Indicates separate provider involvement.
⚖️ Difference Between CPT 91035 and 00812
CPT 91035 and CPT 00812 represent unrelated procedures.
CPT 91035 is used for reflux diagnosis, while CPT 00812 represents anesthesia services
???? Billing Errors to Watch Out for in CPT 91035
1️⃣ Modifier Confusion
Incorrect modifier selection for CPT 91035, the reimbursement can be delayed. Always review payer-specific rules before submission.
2️⃣ Poor Claim Documentation
Improperly filled forms can lead to claim rejection. Ensure completeness in every billing field, including documentation of service level
???? Final Thoughts
GERD is diagnosed through pH monitoring that measures read more acid exposure in the esophagus.
Providers submit CPT 91035 to insurers to ensure correct payment. Correct modifier usage and proper claim preparation boost claim acceptance rates.