A comprehensive manometric examination of esophageal motility includes evaluation of the lower esophageal sphincter (LES), the esophageal body, the upper esophageal sphincter (UES), and in some instances the pharynx.
If esophageal manometry (91010 or 91011) and acid perfusion studies (91030) are reported as separate procedures, they should be combined under code 91012.
When any combination of the above procedures are performed in conjunction with gastric motility (manometric) studies (91020), they should be combined as 91020.
48-hour catheter free, wireless esophageal pH monitoring (i.e., Bravo pH Monitoring System-91035) is considered experimental/investigational. There is a lack of published data in peer reviewed medical journals and it is unclear whether this service provides any additional health benefits as an alternative to conventional catheter based 24-hour esophageal monitoring. How an increased length of monitoring time (up to 48 hours) might benefit patient management is unknown. A participating, preferred, or network provider can bill the member for the denied service.
The Bilitec 2000 is considered experimental/investigational. There is a lack of published peer-reviewed literature assessing the clinical utility of Bilitec 2000. Additional studies are needed to determine the role of this procedure in evaluating patients with duodenogastroesophageal reflux. A participating, preferred, or network provider can bill the member for the denied service.
Description
Gastroesophageal reflux disease (GERD) is associated with heartburn, acid regurgitation, peptic esophagitis, Barrett’s esophagus, esophageal stricture, some cases of asthma, posterior laryngitis, chronic cough, dental erosions, chronic hoarseness, pharyngitis, subglottic stenosis or stricture, nocturnal choking, and recurrent pneumonia. GERD is usually diagnosed by clinical history and endoscopy, and is treated empirically with a trial of medical management.
Conventional catheter-based pH monitoring involves the placement of a catheter with a pH electrode attached to its tip at 5 cm above the upper margin of the lower esophageal sphincter (LES) using manometric location. The electrode is attached to a data logger worn on a waist belt or shoulder strap. Every instance of acid reflux as well as its duration and pH is recorded, indicating gastric acid reflux over a 24-hour period. Patient recorded symptoms can then be temporally related to acid reflux events.
More recently, a catheter free, temporarily implanted device (i.e., Bravo pH Monitoring System) has received FDA approval for the purposes of esophageal monitoring. Using endoscopic guidance, the capsule is temporarily implanted in the esophageal mucosa using a pin. The capsule records pH levels for up to 48 hours and transmits them via radio frequency telemetry to a receiver worn in the patient’s belt. Data from the recorder is uploaded to a computer for analysis.
Bilitec 2000 is a fiberoptic spectrophotometer developed for use in evaluating reflux disorders in the gastrointestinal tract. This test measure bile, using sensors in the patient, and records the frequency and duration of bile exposure in either the stomach or the esophagus over a 24-hour period. It is typically, performed in an ambulatory setting independent of esophageal pH. A special diet is required to avoid interference and false readings. A trained technician and/or physician are the main users of the system. This system is similar to those used for ambulatory esophageal pH monitoring. | 
