CPT code 91011 is a medical billing code used for an esophagus motility study, which assesses how well the esophagus functions.
CPT code 91011 is used to describe an esophagus motility study, which is a diagnostic test that evaluates the function and movement of the esophagus. This procedure measures the pressure and pattern of muscle contractions in the esophagus as a patient swallows, helping healthcare providers assess conditions such as dysphagia, gastroesophageal reflux disease (GERD), and other esophageal disorders.
For CPT code 91011 (Esophagus motility study), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. This could be due to the complexity of the patient's condition or other factors that necessitate additional effort.
2. Modifier 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the study, not the technical component.
3. Modifier 52 - Reduced Services
- Apply this modifier when the procedure is partially reduced or eliminated at the physician's discretion. This could occur if the full study is not completed due to patient intolerance or other reasons.
4. Modifier 53 - Discontinued Procedure
- Use this modifier when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient. This is different from a reduced service as it indicates the procedure was started but not completed.
5. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used when the same physician performs a repeat procedure or service on the same day. It indicates that the procedure was necessary to be repeated for the same patient.
6. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier when a procedure or service is repeated by another physician on the same day. It indicates that the repeat procedure was necessary and performed by a different provider.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- This modifier is used when the patient requires an unplanned return to the operating or procedure room for a related procedure during the postoperative period of the initial procedure.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
- This modifier is used when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results. It indicates that the repeat test is necessary for the patient's condition.
These modifiers help provide additional information about the circumstances under which the esophagus motility study was performed, ensuring accurate billing and reimbursement.
The CPT code 91011 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and it is updated annually to reflect changes in policy and practice.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) have the authority to interpret national policies and make local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to ensure accurate and up-to-date information regarding the reimbursement of CPT code 91011.
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