Gastroenterology Coding Alert

Check method of choice to guide your coding.

When your physician suspects a patient of having gastric ulcers, duodenal ulcers or carrying a high risk of cancers of the digestive tract, then he may ask for Helicobacter pylori (H.pylori) testing — but do you know what codes are involved?

Read our advice to update yourself about the various coding choices that you can report from when your gastroenterologist undertakes a test for H.pylori.

Confirm Material Used for Reporting Breath Tests

Your gastroenterologist might rely on a urea breath test (UBT) to test for the presence of H. pylori. “If an infection is present then the bacterium’s urease enzyme breaks down urea in the stomach releasing carbon dioxide. Urea provided to the patient is either labeled with carbon-13 (a non-radioactive, stable form) or with carbon-14 (a low level radioactive form),” says Michael Weinstein, MD, the Chair of Health Policy for DHPA.

When your gastroenterologist opts for a breath test, “you should determine the brand name of the H. pylori breath test kit and review their material about test carbon labeled material type and their CPT^® coding recommendation,” adds Weinstein. “In almost all cases, the breath test performed in an ambulatory office will be a carbon-13 form because the radioactive carbon-14 form requires special handling and a nuclear medicine facility.”

If your gastroenterologist prefers to use a C-13 breath test, then you report the test with 83013 (Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope [e.g., C-13]) for the analysis that your gastroenterologist provides assuming the analysis in done in the office. If the sample was sent out to another laboratory for analysis, then you only have to report the acquisition of the sample. The documentation will show that the patient consumed a drink containing carbon-urea and water. The administration of the non-radioactive isotope should be reported with 83014 (Helicobacter pylori; drug administration).

In the test documentation, if you see that the patient was provided a capsule with carbon-urea and a low dose radioactive material, then you can know that the patient was subject to a C-14 breath test. To report a C-14 breath test that your gastroenterologist has performed, you need to use 78267 (Urea breath test, C-14 [isotopic]; acquisition for analysis).

But if you only report the test with 78267, it does not cover the analysis of the sample. In case your gastroenterologist is also performing the analysis, you need to additionally report 78268 (Urea breath test, C-14 [isotopic]; analysis). If the sample was sent out to another laboratory for analysis, then you only have to report the acquisition of the sample with 78267 and the laboratory reports 78268.

Remember: When your practice provides the supply of the radioactive isotope that is administered to the patient, don’t forget to report this A4641 (Radiopharmaceutical, diagnostic, not otherwise classified).

Observe Caution When Reporting an E/M on the Same Calendar Date

When your gastroenterologist administers a C-13 or a C-14 breath test, you need to be careful about reporting an E/M code for the office visit. You cannot use an E/M code if your gastroenterologist only performed the administration and/ or analysis of the breath test for H. pylori.

But you can report an E/M code if your gastroenterologist provided other services that is best described by the appropriate E/M code. But you need to provide sufficient documentation to support the E/M services that were performed along with documenting the necessity of these services that your gastroenterologist performed.

Zero in on Code for Stool Sampling

If your gastroenterologist relies on a stool sample to test for H. pylori infection, you report the analysis with 87338 (Infectious agent antigen detection by immunoassay technique, [eg., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]] qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool).

Capture These Codes for Endoscopy With Biopsy

Another method that your gastroenterologist might prefer to use, especially when checking for presence of H. pylori infections in a patient with a suspected lesion in the stomach, is testing a biopsy specimen from the stomach obtained during a diagnostic endoscopy. The biopsied specimen is checked for presence of H. pylori infection by using a commercial rapid urease or CLO (campylobacter-like organism) test kit.

If your gastroenterologist decides to perform an endoscopy to evaluate symptoms and identifies an ulcer or areas of gastritis then a biopsy will usually be obtained to check for the presence of a H. pylori infection. You will report the endoscopy with biopsy first with 43239 (Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple). You report the tissue biopsy analysis with 87077 (Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate). Don’t forget to append the modifier QW (CLIA waived test) to 87077 for CLIA (Clinical Laboratory Improvement Amendments) waived labs. For higher-CLIA complexity labs and non-Medicare payers, you may report 87081 (Culture, presumptive, pathogenic organisms, screening only).