???? 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, clinics often outsource medical billing to streamline cash flow.

???? Definition and Explanation of CPT Code 91035

The American Medical Association (AMA) created coding standards to simplify payments. CPT 91035 reports a gastroesophageal reflux test, popularly called the Bravo Capsule code. This procedure uses Bravo Capsule placement to record esophageal acid exposure. Detailed reporting ensures accurate reimbursement.

???? Applicable Modifiers for CPT 91035

Multiple modifiers can accompany CPT 91035 under different clinical circumstances. Let’s review them:

• Modifier 26: Indicates the physician’s portion of service.


• Modifier TC: Covers the technical component


• Modifier 52: Used when service is partially reduced


• Modifier 53: Applied when treatment stops for patient safety


• Modifier 59: Reports separate, non-overlapping procedures.


• Modifier 76: Indicates repeated service.


• Modifier 77: Indicates separate provider involvement.

⚖️ Is CPT Code 91035 Related to CPT Code 00812?

No, they are not related.
CPT 91035 is used for reflux diagnosis, while more info CPT 00812 represents anesthesia services

???? Billing Errors to Watch Out for in CPT 91035

1️⃣ Using the Wrong Modifier

When coders choose the wrong modifier for CPT 91035, it could lead to billing rejections. Always review payer-specific rules before submission.

2️⃣ Poor Claim Documentation

Improperly filled forms can cause reimbursement delays. Ensure clarity in every billing field, including documentation of service level

???? Final Thoughts

To detect reflux disease, doctors perform more info pH testing using telemetry electrodes.
Providers use CPT 91035 for reimbursement to receive appropriate reimbursement. Correct modifier usage and precise billing optimize the revenue cycle.