CPT code 91013 is a procedure code for esophageal motility testing with stimulation and perfusion, used to assess swallowing disorders.
CPT code 91013 is for esophageal motility studies with stimulation and perfusion. This procedure involves measuring the movement and function of the esophagus while applying specific stimuli and administering a fluid infusion. It helps healthcare providers assess conditions related to esophageal motility disorders, providing valuable insights into the patient's swallowing function and esophageal health.
For CPT code 91013, which pertains to esophageal motility studies with stimulation or perfusion, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to provide a service is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the procedure.
2. Modifier 26 - Professional Component
- Indicates that the service provided was the professional component only, such as the interpretation of the test results, rather than the technical component.
3. Modifier 52 - Reduced Services
- Applied when a service or procedure is partially reduced or eliminated at the physician's discretion. This could occur if the full esophageal motility study was not completed.
4. Modifier 53 - Discontinued Procedure
- Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service
- Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 - Repeat Procedure by Same Physician
- Used when the same physician repeats a procedure or service on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Indicates that a procedure or service was repeated by another physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Used when a patient returns to the operating room for a related procedure during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Applied when a procedure or service performed during the postoperative period is unrelated to the original procedure.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
- Used when a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent test results.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 91013 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates and guidelines for services covered under Medicare Part B.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and reimbursement policies for this CPT code. Providers should consult the MPFS and their respective MAC to ensure compliance with all billing and documentation requirements to secure appropriate reimbursement for CPT code 91013.
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