???? Understanding CPT Code 91035 for GERD Diagnosis

Introduction:

GERD diagnosis requires precise acid monitoring between stomach and esophagus.
In medical billing, CPT Code 91035 is billed for the gastroesophageal reflux test. Proper documentation during claim submission is essential for correct reimbursements. Therefore, providers often partner with billing experts to streamline cash flow.

???? Definition and Explanation of CPT Code 91035

The American Medical Association (AMA) establishes guidelines for billing accuracy. CPT 91035 applies to a gastroesophageal here reflux test, also known as the Bravo Capsule code. This procedure helps track acid reflux through pH monitoring. Detailed reporting ensures accurate reimbursement.

???? Applicable Modifiers for CPT 91035

Multiple modifiers can accompany CPT 91035 under unique clinical circumstances. Let’s review them:

• Modifier 26: Used for interpretation and report only


• Modifier TC: Reports the procedural performance aspect.


• Modifier 52: Indicates reduced service.


• Modifier 53: Used if the procedure is discontinued


• Modifier 59: Indicates a distinct procedure performed the same day


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


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

⚖️ Difference Between CPT 91035 and 00812

CPT 91035 and CPT 00812 represent unrelated procedures.
CPT 91035 covers gastroesophageal pH monitoring, while CPT 00812 is assigned for colonoscopy anesthesia billing.

???? Common Mistakes to Avoid When Billing CPT Code 91035

1️⃣ Incorrect Modifier Usage

If staff use modifier 77 instead of 59 for CPT 91035, claims may be denied. Always verify the correct modifier before submission.

2️⃣ Inaccurate Documentation

Incomplete or incorrect details can result in denied payments. Ensure completeness in every billing field, including all claim data.

???? Key Takeaway

Gastroesophageal reflux disease diagnosis involves analyzing acid backflow here with pH monitoring.
Providers submit CPT 91035 to insurers to receive appropriate reimbursement. Correct modifier usage and precise billing boost claim acceptance rates.