Health Information Management

Capsule colonoscopy

APCs Insider, November 13, 2003

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November 14, 2003
Vol. 4, No. 45


Celebrity Coding

This singer succumbed to anorexia in 1983. Name the celebrity and the code.

The answer will appear in next week's APC Weekly Monitor, or be one of the first five to e-mail the correct answer and win a 3-month free trial to one of our HCPro newsletters!

Julia Roberts suffered from what disease in the movie Steel Magnolias? Name the code.


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Keith Siddel
MBA, PhD (c),
president, CEO
HRM, Hospital Resource Management

Andrea Clark
Health Revenue Assurance Associates

Cheryl D'Amato
director, health information management
HSS, Inc.

Julie Downey
ambulatory coding coordinator, HIM
University Colorado Hospital

Carole Gammarino

Jeannie Gourgeot
Director of HIMS
St. Joseph's Medical Center

Julia R. Palmer
president, Health Information Management Division

Valerie Rinkle
revenue cycle director
Asante Health System




Today's topic

Today's question concerns capsule colonoscopy, a relatively new procedure that spurred the creation of CPT code 91110. Read on to find out more about this procedure and how to code for it.

Your APCs Weekly Monitor is a free weekly e-zine from HCPro, publisher of Briefings on APCs, the monthly newsletter devoted entirely to managing under APCs, and the newsletter, APC Answer Letter, with answers to readers' questions about coding for APCs.

The Monitor is a complimentary companion publication with a specific mission: to provide answers to your tough questions about the APC regulations.

If you have a question about APC coding that you would like addressed in the Monitor, post it on our Web site at Each week, our team of experts answers a question that will appeal to the majority of readers. The elected question and the corresponding answer are delivered to your inbox every Friday.

TODAY'S TOPIC: Capsule colonoscopy

QUESTION: What is a "capsule colonoscopy," how is the procedure done, and how should we code it?

ANSWER: According to several local medical review policies (LMRPs) from Medicare Fiscal Intermediaries (FIs), capsule colonoscopy or telemetric gastrointestinal capsule imaging is a noninvasive diagnostic imaging device for viewing the gastrointestinal tract, especially the small bowel, which is not accessible through standard upper endoscopy and colonoscopy. The patient swallows a small capsule (approximately 11 x 26 mm) that transmits video pictures as peristalsis propels the capsule through the GI tract. These video images are transmitted to sensors taped to the body and stored on a portable recorder. As the capsule passes through the GI tract, the strength of the signal is used to calculate its position. The stored images are later downloaded to a computer, from which they may subsequently be viewed in real time. The capsule passes naturally from the body with the stool, and since it is disposable, is not recovered.

This test is indicated for the diagnosis of obscure gastrointestinal bleeding when the site of which has not previously been identified by upper gastrointestinal endoscopy, colonoscopy, push enteroscopy, or radiologic procedure. It may be especially helpful in the diagnosis of angioectasias of the GI tract.

There are limitations to Medicare coverage of this procedure. Check the LMRP from your FI for specific coverage circumstances and ICD-9-CM codes that support medical necessity.

Effective January 1, 2004, report this procedure as 91110, GI tract capsule endoscopy (interim APC 1508, $650.00 national unadjusted "S" status indicator). For dates of service prior to January 1, 2004, report G0262, small intestinal imaging; intraluminal, from ligament of treitz to the ileo cecal valve, includes physician interpretation and report. Payers that do not accept HCPCS Level II codes may prefer 91299, unlisted diagnostic gastroenterology procedure.

PAY PER VIEW: 2004 Work Plan expands upon, overlaps past years'

This year's Work Plan, issued by the Office of Inspector General (OIG) on October 1, has fewer coding and billing initiatives and more topics related to quality of care, accreditation, and drug reimbursement.

Click HERE to read more. The cost is $10. Medical Records Briefings subscribers have free access via their online subscriptions.

ASK THE EXPERT: Our ED physicians frequently use "musculoskeletal pain" as a final diagnosis, regardless of the pain's origin and cause (e.g., falling without any fractures, but hurting all over; involved in a collision, with generalized pain). For this situation, should we use the general symptom code 780.99, or the double code 729.1/733.90?

Click here for the EXPERT'S answer.

Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.


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Master, then implement the 2004 CPT codes

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