Gastroenterology Coding Alert

Question: What CPT code do we use to report a Helicobacter pylori stool test? Will Medicare reimburse for the test?

Arizona Subscriber

Answer: In February 1998, the Food and Drug Administration approved the use of Helicobacter pylori stool tests to establish the presence of H. pylori infection in the gastrointestinal tract and for monitoring patient response during and after treatment. Gastroenterologists may use the stool test in lieu of H. pylori breath testing.

Code 87338 (infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; Helicobacter pylori, stool) should be used to report the laboratory analysis of the test. Unlike the H. pylori breath tests, there is no code to report the collection of the sample for the stool test.

The question of Medicare reimbursement for the laboratory test will vary from carrier to carrier. In a memorandum dated Oct. 18, 1999, Medicare decided against establishing a national coverage policy for the test because of concerns over the dynamic changes, which are occurring in the development of non-invasive H. pylori diagnostics and left the final decision concerning reimbursement to local Medicare carriers.

A new local medical review policy for your state of Arizona went into effect Oct. 1, 2000, and indicates that local carrier, Noridian Mutual Insurance, will reimburse for the test. Medicare carriers in New York, New Jersey, Ohio, Illinois and Pennsylvania are among those that also have announced coverage of 87338.

The amount of reimbursement also will vary. In Arizona, the clinical lab fee for the stool test has been set at $55, which is similar to the fee in New York and New Jersey. HGS Administrators, Pennsylvanias carrier, has established a much lower rate of $15.88.

Unlike the H. pylori breath tests, the stool tests must be analyzed by a laboratory that is CLIA (Clinical Laboratory Improvement Amendments)-certified.

For more on coding for H. pylori breath tests, see Ensure Proper Reimbursement for H. pylori Breath Tests on page 36 of the May 2000 Gastroenterology Coding Alert.

Additional information for this months Reader Questions was provided by Pat Stout, CMT, CPC, an independent coding consultant in Knoxville, Tenn.