This policy lays out coding and payment guidelines for procedures performed on the digestive system.

CPT Codes
40490-49999

Esophagus Acid Reflex Tests:
Esophagus acid reflex tests (91032-91033) are covered services
for certain conditions.

CPT Codes
91032   Esophagus, acid reflux test, with intraluminal pH electrode
             for detection of gastroesophageal reflux;
91033   prolonged recording

ICD-9 Codes That Support Medical Necessity
530.0      Achalasia and cardiospasm
530.10    Esophagitis, unspecified
530.11    Reflux esophagitis
530.19    Esophagitis other specified
530.2      Ulcer of esophagus
530.3      Stricture and stenosis of esophagus
530.4      Perforation of esophagus
530.5      Dyskinesia of esophagus
530.6      Diverticulum of esophagus, acquired
530.7      Gastroesophageal laceration-hemorrhage syndrome
530.81    Esophageal reflux
530.82    Esophageal hemorrhage
530.83    Esophageal leukoplakia
530.84    Tracheoesophageal fistula
530.89    Esophageal disorder other
530.9      Esophagus disorder unspecified
531.00    Gastric ulcer, acute with hemorrhage without mention
               of obstruction
531.01    Gastric ulcer, acute with hemorrhage with obstruction
531.10    Gastric ulcer, acute with perforation without mention
               of obstruction
531.11    Gastric ulcer, acute with perforation with obstruction
531.20    Gastric ulcer, acute with hemorrhage and perforation
               without mention of obstruction
531.21    Gastric ulcer, acute with hemorrhage and perforation
               with obstruction
531.30    Gastric ulcer, acute without mention of hemorrhage, 
               perforation, or obstruction
531.31    Gastric ulcer, acute without mention of hemorrhage or
               perforation with obstruction
531.40    Gastric ulcer, chronic or unspecified with hemorrhage
               without mention of obstruction
531.41    Gastric ulcer, chronic or unspecified with hemorrhage
               with obstruction
531.50    Gastric ulcer, chronic or unspecified with perforation
               without mention of obstruction
531.51    Gastric ulcer, chronic or unspecified with perforation
               with obstruction
531.60    Gastric ulcer, chronic or unspecified with hemorrhage
               and perforation without mention of obstruction
531.61    Gastric ulcer, chronic or unspecified with hemorrhage
               and perforation with obstruction
531.70    Gastric ulcer, chronic without mention of hemorrhage,  
               obstruction or perforation
531.71    Gastric ulcer, chronic without mention of hemorrhage or
               perforation with obstruction
531.90    Gastric ulcer, unspecified as acute-chronic, without mention
               of hemorrhage, perforation, or obstruction
531.91    Gastric ulcer unspecified as acute-chronic, without mention
               of hemorrhage or perforation with obstruction

Coding Guidelines
According to Medicare, the C-14 Xylose breath test (91299) is a
covered service and is used to detect small bowel bacterial over-
growth. Reimbursement will be based on procedure code 91605
(breath hydrogen test for lactose deficiency). All claims are to
be submitted manually.

CPT code 43259 is upper gastrointestinal endoscopy including endoscopic ultrasound (EUS).  If the person doing the original
endoscopy has access to the EUS and if the clinical situation is appropriate, the EUS may be done at the same time. The procedure, diagnostic and EUS, would be reported under the same code because
the code, CPT code 43259, includes diagnostic endoscopy.

Therefore, when a diagnostic examination of the upper gastrointestinal tract "including esophagus, stomach, and either the duodenum or  jejunum as appropriate", includes the use of endoscopic ultrasono- graphy, the service should be reported by a single code, namely CPT code 43259. Interpretation, whether by a radiologist of endoscopist,
is reported under CPT code 76975-26. These codes may both be
reported on the same day.

As per Medicare, implantation of an anti-gastroesophageal reflux
device (43499) may be considered reasonable and necessary when
a conventional valvuloplasty procedure is contraindicated. The device
is covered only for patients with documented severe or life-threatening gastroesophageal reflux disease whose conditions have been resistant
to medical treatment.

Laparoscopic cholecystectomy is a surgical procedure in which a diseased gall bladder is removed through the use of instruments introduced via cannulae, with vision of the operative field maintained
by use of a high-resolution television camera-monitor system (video
laparoscope).

For all other claims use CPT codes 56340 for laparoscopy, surgical; cholecystectomy (any method), 56341 for laparoscopy, surgical; cholecystectomy with cholangiography, and 56342 for laparoscopy, surgical; cholecystectomy with exploration of common duct.

Omental flap (e.g., for reconstruction of sternal and chest wall defects) (list separately in addition to code for primary procedure) (49905).