???? Understanding CPT Code 91035 for GERD Diagnosis

Introduction:

The gastroesophageal reflux test monitors acid abnormalities in the stomach.
In medical billing, CPT Code 91035 applies to the gastroesophageal reflux test. Accurate coding during claim submission is essential for correct reimbursements. Therefore, healthcare organizations often outsource medical billing to streamline the revenue cycle.

???? Definition and Explanation of CPT Code 91035

The American Medical Association (AMA) establishes guidelines for billing accuracy. CPT 91035 applies to a gastroesophageal website reflux test, also known as the Bravo Capsule code. This procedure uses Bravo Capsule placement to record esophageal acid exposure. Proper documentation supports payer understanding.

???? Applicable Modifiers for CPT 91035

Several modifiers can accompany CPT 91035 under specific clinical circumstances. Let’s go through them:

• Modifier 26: Used for interpretation and report only


• Modifier TC: Refers to the equipment and technician cost


• Modifier 52: Applied when part of the procedure is omitted


• Modifier 53: Used if the procedure is discontinued


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


• Modifier 76: Applied when test is repeated on same day


• Modifier 77: Used when another physician performs the same test

⚖️ Is CPT Code 91035 Related to CPT Code 00812?

CPT 91035 and CPT 00812 represent unrelated procedures.
CPT 91035 is used for reflux diagnosis, more info while CPT 00812 is assigned for colonoscopy anesthesia billing.

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

1️⃣ Modifier Confusion

When coders choose the wrong modifier for CPT 91035, claims may be denied. Always double-check the CPT pairing before submission.

2️⃣ Inaccurate Documentation

Improperly filled forms can lead to claim rejection. Ensure clarity in every billing field, including all claim data.

???? Conclusion

GERD is diagnosed through pH monitoring that measures acid exposure in the esophagus.
Providers use CPT 91035 for reimbursement to ensure correct payment. Correct modifier usage and precise billing boost claim acceptance rates.