ASGE members may submit coding inquiries electronically to codingquestions@asge.org. Each month ASGE gets dozens of questions from members. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Below are two questions that could be beneficial to your practice.
Question #1
Can you explain the difference between CPT code 91065 vs 83013 and 83014? We sometimes get an authorization for 83013/83014 and a 91065 is done. Is there an easy way for the authorization staff to know which test needs to be done?
Answer
Both 91065 and 83013 series are breath tests but are for different conditions.
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91065 (Breath hydrogen or methane test (e.g., for detection of lactase deficiency, fructose intolerance, bacterial overgrowth, or oro-cecal gastrointestinal transit)
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83013 (Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (e.g., C-13)
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83014 (Helicobacter pylori; drug administration)
It is up to your provider to specify which breath test is being ordered. If it isn’t clear your staff should go back to the provider and have them do a legal late entry for the specific indication.
Question #2
Do you think it is necessary or appropriate to send an advanced beneficiary notice (ABN) to a Medicare beneficiary scheduled for a screening colonoscopy? I believe it is not and think the best practice is to look up the Medicare beneficiary on the local Medicare contractor’s website and check the eligibility for another screening. My staff expressed concern about screenings that turn diagnostic and/or screenings where a polyp is found, and therfore would not be covered by Medicare. I thought you can still bill a screening diagnosis as primary if that was the reason for the appointment, assuming there is no history of polyps, etc.
Answer
You never want to "routinely" have ABN forms filled out for Medicare screening patients. The only instance you would complete an ABN form is when you know the patient had a prior screening and it is too early for their next benefit. The patient would have to be informed before the procedure and agree to be billed should Medicare not cover it. There should not be an issue with a screening that results in a polyp removal therapeutic service. These procedures should be billed to Medicare with a modifier PT which specifically means screening converted. The patient's deductible is waived but the patient is still responsible for 20% coinsurance.