Health Information Management

Guidelines for reporting 91035 same as C9712

APCs Insider, December 17, 2004

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Guidelines for reporting 91035 same as C9712

Question: Since C9712 is deleted for 2005 and it appears providers are to report 91035 in its place, should providers report the additional CPT code or codes for the EGD done at the same time?

Answer: As of January 1, 2005, C9712 (Insertion of a pH capsule for measurement and monitoring of gastroesophageal reflux disease, includes data collection and interpretation), is deleted, and replaced with 91035 (esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation). This procedure groups to new technology APC 1506 with a payment rate of $450.00.

Medicare's previous coding direction regarding C9712 states that it may involve a single endoscopy (CPT 43200 or 43235). If the single endoscopy is performed, report it separately, but only one time. Follow this same direction when reporting 91035.

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