Gastroenterology Coding Alert

Here's why you need to use modifier QW for 87077To appropriately report Helicobacter pylori (H. pylori), you must turn to an array of codes in different sections of the CPT manual. Our experts break down your coding choices and show that your selection will depend on the gastroenterologist's preference and the patient's medical condition.For C-14 Breath Test, Use 78267-78268First of all, take a look at C-14 breath tests.What happens: The patient takes a capsule containing carbon-urea with a low dosage of a radioactive material. If H. pylori is present, it breaks down the urea into carbon dioxide, which the patient then exhales. The gastroenterologist can then measure it in the patient's breath. Ten minutes later, the patient provides a breath sample for analysis by blowing up a balloon. A testing laboratory or the gastroenterologist can perform the analysis in-office using equipment called a liquid scintillation counter.You should report the administration of the C-14 breath test with 78267 (Urea breath test, C-14 [isotopic]; acquisition for analysis). If the gastroenterologist also performs the breath analysis, you should report 78268 (... analysis) for that step. Watch out: If the physician sends the breath sample out for analysis, the laboratory reports the service with 78268.Beware: You might need to be careful reporting an office visit and the breath test on the same day. "It's the usual issue," says Marvel J. Hammer, RN, CPC, CSS-P, ACS-PM, CHCO, with MJH Consulting in Denver. You can report an E/M code only if the physician's documentation supports that the E/M service meets the medical necessity and was more than just the administration and/or analysis of the diagnostic test.In other words, you cannot report an E/M service (such as 99211, Office or other outpatient visit ...) if the patient is merely taking the breath test. You should include the nonphysician work of acquisition and/or analysis in 78267-78268.Don't forget: If your practice provides the radioactive isotope for this procedure, you should include A4641 (Radiopharmaceutical, diagnostic, not otherwise classified).Non-Radioactive Testing? Look to C-13 CodesFor non-radioactive technology of the C-13 breath test, you should use 83013 (Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope [e.g., C-13]) and 83014 (... drug administration). You should use 83013 and 83014 "for H. pylori diagnostic tests, such as breath and blood specimens, that are based on C-13 technology for diagnosis," says Joel V. Brill, MD, AGAF, chief medical officer at Predictive Health LLC in Phoenix. What happens: In the C-13 breath test, the physician collects a baseline breath sample, and then the patient drinks a solution of carbon-urea in water. The physician collects subsequent breath samples at timed intervals and typically sends them to a laboratory for analysis.Note: Blood specimens can be tested for [...]