Gastroenterology Coding Alert

Question: Our gastroenterologist used a C-14 breath analysis to test for H. pylori in an established patient. The patient's sample was sent to a laboratory for analysis. How should I code this visit?

New Mexico Subscriber

Answer: Report the administration of the C-14 breath test 78267 (Urea breath test, C-14; acquisition for analysis). Since the physician did not perform the breath analysis, you cannot bill for that step; the laboratory gets that privilege.
 
H. pylori is a bacterium that can grow heartily in the stomach and, occasionally, the duodenum. Its presence irritates these areas and can lead to gastritis and peptic ulcer disease. H. pylori has even been linked with the onset of gastric adenocarcinoma.
 
The C-14 breath test involves the patient swallowing a capsule containing carbon-urea. If H. pylori is present, it breaks down the urea into carbon dioxide, which can be measured in the patient's breath after it is harvested with a balloon.
 
Although this example showcases the use of off-site laboratory analysis, gastroenterologists can analyze H. pylori tests in their own offices with a liquid scintillation counter. If your office performs lab analysis on tests for H. pylori, you can code for the breath test with 78267 and the analysis with 78268 (Urea breath test, C-14; analysis). Be careful when coding both, though. Some payers will not accept the breath test and the analysis separately if they are conducted on the same day. If there is any uncertainty before filing a claim, check with the carrier first to avoid a rejection.