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Coding for capsule endoscopy depends on which structures the physician wishes to view. For imaging of the esophagus only, using a PillCam ESO or similar Food and Drug Administration (FDA)-approved device, the correct CPT® code is 91111 Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus with physician ...
To support medical necessity for endoscopy by capsule of the small bowel, ICD-10-CM code Z98.890 or Z98.891 plus one (or more) of the ICD-10-CM codes listed below must be reported. ICD-10-CM codes D12.0-D12.5 should be reported for patients with polyposis syndrome that may have small bowel neoplasia.
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.
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)
Capsule Endoscopy is not covered for colorectal cancer screening. Capsule endoscopy of the esophagus has been used by some practitioners for patients with suspected gastroesophageal reflux disease, Barrett's Esophagus, or esophageal varices.
CPT© codes in this series (43235-43259) identify services performed during an esophagogastroduodenoscopy. Coding Tip - Beginning January 1, 2017, moderate sedation is no longer included in payment for gastrointestinal endoscopy services.
Capsule endoscopy is a wireless noninvasive diagnostic imaging device for use in viewing the gastrointestinal tract, especially the small bowel, which is not accessible to standard upper endoscopy and colonoscopy.
CPT 91110 is a medical billing code used for gastrointestinal tract imaging through capsule endoscopy, which involves the use of a small, ingestible camera to capture images of the digestive tract from the esophagus to the ileum.
The test is indicated for the diagnosis of occult gastrointestinal bleeding, the site of which has not been identified previously by any of the following: upper gastrointestinal endoscopy, colonoscopy, push enteroscopy, nuclear imaging, or radiological procedures.
The main CPT code for wireless capsule endoscopy of the small bowel is 91110. For wireless capsule endoscopy of the esophagus through the ileum, the CPT code is also 91110, with the addition of Modifier 52 if the ileum is not visualized. Wireless capsule endoscopy of the esophagus alone is coded with CPT code 91111.