Gastroenterology Coding Alert

Question: We often perform H. pylori tests – which diagnosis codes apply to these visits?

South Carolina Subscriber

Answer: You’ll report the code for the definitive condition, if found, or the symptoms that prompted the test if you don’t have the results back yet (or if the results are negative). Some of the generally accepted ICD-10 codes that you may find in your physician’s notes include the following, among others:

• B96.81 (Helicobacter pylori (H. pylori) as the cause of diseases classified elsewhere)
• C16.0-C16.9 (Malignant neoplasm stomach...)
• K25.0-K25.9 (Gastric Ulcer...)
• K26.0-K26.9 (Duodenal Ulcer... )
• K27.0-K27.9 (Peptic Ulcer...)
• K28.0-K28.9 (Gastrojejunal Ulcer...)
• K29.00- K29.91 (Gastroduodenitis...)
• K30 (Functional dyspepsia)
• Z87.11 (Personal history of peptic ulcer disease)

Remember to check with your payer on which codes are payable by each individual contractor.  B96.81, for example, references diseases classified elsewhere, and some payers might not accept as standalone diagnosis without also reporting a chronic gastritis or ulcer code.