Are you confused between different coding options for capsule endoscopy? Let’s talk about CPT code 91110, one of the popular gastrointestinal imaging codes. As a gastroenterologist or a gastroenterology professional, you might have come across this code before and may have even used it multiple times. But do you know its specifics?
CPT code 91110 may seem like just another code, but you could face claim denials with a single incorrect application. So, what exactly does this code cover? And why is it so confusing? If you want to bill for gastrointestinal imaging accurately, follow our guidelines to understand the purpose and correct application of CPT code 91110.
CPT Code 91110 – Description
The Current Procedural Terminology (CPT) code 91110 describes a non-invasive diagnostic procedure, capsule endoscopy. It involves swallowing a capsule containing a tiny wireless camera to take pictures as it travels through the digestive system.
In simple terms, this procedure covers the entire length of a GI tract, starting from the esophagus, passing through the stomach, and ending at the final part of the small intestine (ileum). The primary purpose? To identify issues in the digestive tract, including Crohn’s disease, ulcerative colitis, celiac disease, or cancer, by analyzing the irritated and inflamed areas in the patient’s small intestine.
In short, CPT code 91110 allows healthcare providers to bill for gastrointestinal tract imaging. It also covers result interpretation and reporting.
Scenarios Where CPT Code 91110 is Applicable
Struggling to use the CPT code 91110 accurately? Look at the following scenarios to learn when and how to use this code:
Crohn’s Disease Diagnosis
Let’s start with performing capsule endoscopy to diagnose Crohn’s disease, a type of inflammatory bowel disease. Assume a 23-year-old man visits a primary care facility. After reviewing his medical history and asking some questions, the doctor notes that he has chronic diarrhea and is currently experiencing persistent abdominal pain, fatigue, and rapid weight loss.
The doctor also reviews the patient’s previous negative ileocolonoscopy results but still suspects Crohn’s disease. To confirm his suspicion, he performs a capsule endoscopy. He then uses CPT code 91110 to bill for this diagnostic test.
Refractory Celiac Disease Analysis
But what if the condition is already known? Can you use this code to report capsule endoscopy for refractory symptoms analysis?
Suppose a 52-year-old woman with known celiac disease continues to experience deteriorating health despite strictly adhering to a gluten-free diet for the past year. She arrives with general complaints of anemia, unexplained weight loss, persistent diarrhea, malaise, and abdominal pain.
The gastroenterologist suspects refractory celiac disease (RCD) and performs a capsule endoscopy to look for villous atrophy (erosion of tiny cells lining the small intestine). He confirms the diagnosis, documents the results, and uses CPT code 91110 to report this procedure.
Small Bowel Tumor Detection
What if you performed a capsule endoscopy to detect tumors? A 59-year-old man arrives at an outpatient clinic with unexplained abdominal pain, nausea, and a change in bowel habits. After a brief discussion and a review of the patient’s medical records, the doctor learns about his family history of small bowel cancer, specifically adenocarcinomas.
The healthcare provider performs a capsule endoscopy to visualize the patient’s small intestine. This procedure allows him to detect a small bowel tumor. The doctor interprets and documents the results and hands everything to the billing team. They use CPT code 91110 to request reimbursement from the appropriate payer.
Applicable Modifiers for CPT Code 91110
Want to clarify how you performed the capsule endoscopy? You can use one of the following modifiers:
Modifier 26
You can use modifier 26 to report that you only interpreted and documented the results of capsule endoscopy. In simple words, you can use it to bill the professional component of the service.
Modifier TC
For the technical component, such as providing the capsule, hooking up equipment, and downloading data, append modifier TC to CPT code 91110. This modifier helps healthcare providers receive compensation for their time and equipment.
Modifier 52
If you only examined a specific part of the patient’s gastrointestinal tract, use modifier 52. Simply put, this code allows healthcare providers to report reduced services. In this case, you should use it to notify payers that the performed capsule endoscopy was less extensive than the defined procedure in CPT code 91110.
Modifier 59
If capsule endoscopy is distinct and separately identifiable from other services performed on the same day, use modifier 59. However, check the NCCI edits before reporting CPT code 91110 with another code.
Modifier XE
For more specificity, you can use one of the NCCI-associated X{EPSU} modifiers. Use modifier XE if you performed capsule endoscopy at a separate encounter on the same day.
Important Note: This diagnostic procedure is quite safe and does not require anesthesia. Therefore, billing teams rarely apply modifier 53 to CPT code 91110.
CPT Code 91110 – Billing & Reimbursement Guidelines
Want to accurately bill CPT code 91110? Follow our instructions:
Verify Medical Necessity
This is the most important step. Don’t want to absorb the cost of capsule endoscopy? Always verify medical necessity before performing a capsule endoscopy. For example, Medicare only covers this procedure for diagnosing obscure gastrointestinal bleeding if the beneficiary is continuously experiencing GI blood loss or anemia.
Therefore, make sure that you only perform this procedure for a covered diagnosis code, as highlighted on the Centers for Medicare & Medicaid Services (CMS) website.
Maintain Complete Documentation
After verifying medical necessity, maintain complete documentation in the patient’s medical record to justify the procedure. All records should be legible and include appropriate patient information, such as:
- Complete Name
- Date of Service (DOS)
- Symptoms
- Results of prior tests
The last point is extremely important as it explains why a healthcare provider has performed capsule endoscopy. In simple terms, it clarifies that, despite multiple attempts, previous tests, including colonoscopy or endoscopy, failed to identify the actual issue.
Last but not least, your medical documentation should highlight the role of capsule endoscopy in patient treatment. Moreover, don’t forget to include legible signatures of physicians or non-physician practitioners responsible for performing the procedure.
Use CPT Code 91110 for Complete Capsule Endoscopy
Remember that you can only use CPT code 91110 for a complete capsule endoscopy, not for observing a specific part of the digestive tract. This means that the capsule must successfully capture images from the patient’s esophagus through the ileum.
Apply Appropriate Modifiers
Don’t forget to use modifiers when necessary. Different modifiers convey different information:
- Use modifier 26 if you are only billing for physician interpretation and reporting.
- On the other hand, you can use the TC modifier to report the technical component.
- Append modifier 52 to CPT code 91110 to report reduced services.
- Use modifier 59 if the capsule endoscopy is unrelated to other services.
- Apply modifier GA after obtaining a signed ABN if you believe Medicare may deny the procedure due to lack of medical necessity.
Follow Payer-Specific Guidelines
The best way to avoid billing complications is to comply with payer-specific requirements. Refer to the Local Coverage Determination (LCD) or other relevant documents to understand the limitations of capsule endoscopy. Additionally, follow place of service (POS) requirements to avoid claim denials.
Review Your Claim Before Submission
Finally, after completing all the steps, always review your claim to identify and correct potential errors before submission. This step will help ensure proper and timely reimbursement for capsule endoscopy.
Conclusion
To conclude, CPT code 91110 is quite simple to understand. It refers to a popular non-invasive gastrointestinal diagnostic procedure, capsule endoscopy. However, you cannot perform this procedure if conventional tests, such as colonoscopy or endoscopy, can diagnose digestive tract problems.
Understandably, insurance companies require justification for CPT code 91110, which you can provide by following our instructions. We have covered this code in detail to clear up your confusion. But if you would rather hand over everything to a professional, contact our representative to book an appointment. Our gastroenterology billing services cover everything, including coding.
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