Do you need help with capsule endoscopy medical billing? You have reached the right place.
What is Capsule Endoscopy?
Very quickly, capsule endoscopy is a procedure that involves swallowing a small capsule, which is the size of a large vitamin pill. Inside the capsule is a tiny wireless camera that takes pictures as it passes through the small intestine. Images are transmitted to a recording device worn on a belt around your waist. A capsule endoscopy is used to examine the small intestine (between the stomach and large bowel). It can be helpful in the detection of conditions such as unexplained bleeding, iron deficiency anemia, Crohn’s disease, coeliac disease, leaking blood vessels (angiodysplasia), polyps, or tumors in the small bowel.
Current CPT Codes for Capsule Endoscopy
Here are the CPT codes for capsule endoscopy:
- Wireless capsule endoscopy of the small bowel should be coded with the CPT code 91110.
- Wireless capsule endoscopy of the esophagus through the ileum should be coded with CPT code 91110. (If the ileum is not visualized, add Modifier 52)
- Wireless capsule endoscopy of the esophagus should be coded with CPT code 91111. A dual diagnosis is required when billing this service.
- For gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), and colon, with interpretation and report (investigational) use CPT code 91113.
- Magnetically controlled capsule endoscopy, esophagus through the stomach, including intraprocedural positioning of the capsule, with interpretation and report.
Other Capsule Endoscopy Coding & Medical Billing Guidelines
Wireless capsule endoscopy of the small bowel should be coded with the CPT code 91110, and wireless capsule endoscopy of the esophagus should be coded with CPT code 91111. A dual diagnosis is required when billing this service.
The date of service should be entered as the date of ingestion of the capsule and the date hook-up of the data recorder device was performed regardless of the number of days the recorder is worn.
CPT codes 91110 and 91111 consist of professional and technical components.
The technical portion (TC modifier) of the service includes:
- Provision of the capsule.
- Hook-up of the recording equipment.
- Downloading of the digital data with processing and creation of video images.
ICD 10 Codes
|D50.0||Iron deficiency anemia secondary to blood loss (chronic)|
|D50.9||Iron deficiency anemia, unspecified|
|K92.2||Gastrointestinal hemorrhage, unspecified|
Documentation Requirements for Capsule Endoscopy Medical Billing
All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
- Every record page must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for providing the care to the patient.
- The submitted medical record must support using the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
- The record must include documentation that attempts were made to identify the source of the bleeding, but the site of bleeding was not previously identified by colonoscopy or endoscopy.
- The medical record must reflect why the patient was not a candidate for conventional endoscopy. There must be documentation of specific co-morbidities and complicating medical conditions that lead the performing provider of the conventional endoscopy to believe that the risk/benefit ratio of a conventional endoscopy was not maintained. The medical record must also support how the capsule endoscopy would contribute to the patient’s care.
We hope you found this helpful information. The capsule cost is high, so ensure you are getting paid for every procedure. Get expert help on capsule endoscopy medical billing with PracticeForces. With two decades of experience working with medical practices and providers in diverse specialties, we know what it takes to ace medical billing and turbocharge revenues.
Article reference: Billing and Coding: Wireless Capsule Endoscopy, CMS.gov