CPT code 91038 is for an esophageal impedance function test lasting over one hour, used to assess esophageal conditions.
CPT code 91038 is used to describe an esophageal impedance function test that lasts longer than one hour. This test measures the movement of substances through the esophagus and assesses how well the esophagus is functioning, particularly in relation to swallowing and reflux. It is typically utilized to evaluate patients with symptoms of gastroesophageal reflux disease (GERD) or other esophageal disorders.
For CPT code 91038 (Esoph imped funct test > 1hr), the following modifiers may be applicable:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, typically by the physician interpreting the test results.
2. Modifier TC - Technical Component: Used when only the technical component of the service is being billed, typically by the facility providing the equipment and technical support.
3. Modifier 52 - Reduced Services: Used when the service provided is less extensive than described in the CPT code. For example, if the test was performed for less than the typical duration.
4. Modifier 53 - Discontinued Procedure: Used when the 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: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to avoid bundling issues.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician repeats the procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when a different physician repeats the procedure on the same day.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Used when the same laboratory test is performed multiple times on the same day for the same patient to obtain subsequent (multiple) test results.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 91038, which involves an esophageal impedance function test lasting more than one hour, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for various services covered under Medicare.
Additionally, it is essential to consult with the specific Medicare Administrative Contractor (MAC) for your region, as they administer Medicare claims and can provide detailed information on coverage policies and any potential local variations in reimbursement.
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