Coding corner

How to code a Sitzmarks test

A common test of a patient's gastrointestinal (GI) motility or colonic transit time is the Sitzmarks test, sometimes called the Sitzmarker test. Coders often have questions on how to code such Sitzmarks tests. Here is some clarification.

Konsyl Pharmaceuticals manufactures Sitzmarks, little radio-opaque markers contained in a small capsule with 24 tiny little makers per capsule. The capsule is swallowed like a pill and it then dissolves in the stomach. After the capsule itself has dissolved, the small radio-opaque makers contained in the capsule are free to travel through the GI tract.

These Sitzmarks are small rings about 5 mm in diameter and are made out of polyvinyl chloride (PVC) material. A series of regular flat abdominal X-rays is taken to track the progress of the markers to evaluate GI motility. There are actually three different shaped makers that are available although, of course, only one shape is contained per capsule.

Konsyl Pharmaceuticals has suggested two separate protocols for use of the markers.  Their Simplified Protocol is to administer the capsule at day 0 and obtain a flat abdominal X-ray at day 5 to see how many markers remain in the GI tract and where they are located.  Their slightly more complex Segmental Protocol (also called the Metcalf Protocol) is to administer capsules on day 0, day 1 and day 2, each containing a different shaped set of markers. A regular flat abdominal X-ray is obtained at day 4 and again at day 7.

Of course, the particular protocol the physician may want to use may differ from the ones suggested by Konsyl. Nevertheless, reporting of this test will simply consist of reporting CPT code 74000 (Radiologic examination, abdomen; single anterior posterior view) for the appropriate number of flat KUB X-rays that were done (and conceivably a CPT code for the capsules themselves). If a KUB X-ray was done at day Five, one KUB is reported; if two separate KUBs are done (one at day 4 and one at day 7, then two separate KUBs are reported. If your protocols vary from Konsyl's recommended protocols, simply report the number of KUBs that were performed with the appropriate dates of service. 

Konsyl indicates that CPT code 99070 (Supplies and materials [except spectacles] provided by the physician over and above those usually included with the office visit or other service rendered [list drugs, trays, supplies, or materials provided]) should also be used to report this supply item in addition to reporting the series of KUB X-rays which is obtained to track the progress of the markers through the patient's GI system. Also, these Sitzmarks capsules are available from Konsyl at the price of about $60 for a box of 10 capsules or $6 per capsule. I don't see why this extra supply item can't or shouldn't be reported with 99070, although at a price of $6 per capsule, providers can decide if it's worth the trouble. 

The likelihood of being reimbursed separately for 99070 may vary somewhat based on the payer. In the case of Medicare, 99070 has a status code of "B," so reimbursement for the item has in theory already been calculated into and is already included as part of the reimbursement for the KUBs themselves. Medicare will not also issue another separate additional payment for this "bundled" supply item. You can find an informative Web page for Konsyl's product at: http://www.konsyl.com/physician/index.php

Gregory Schnitzer, CodeRyte, Inc.

CPT codes, descriptions, and other data only are copyright 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply.