Gastroenterology Coding Alert

Question: When a gastroenterologist performs a hydrogen breath test, what are some acceptable conditions to test for? I thought the test was only used to check for a lactase deficiency.


Oklahoma Subscriber
Answer: There has been a change in the parameters governing hydrogen breath tests, and gastroenterologists can now get paid for lactase deficiency checks in addition to several other conditions. In CPT 2005, the American Medical Association amended hydrogen breath test rules to include testing for fructose intolerance, bacterial overgrowth or orocecal gastrointestinal transit.
 
Whenever a gastroenterologist performs a hydrogen breath test to check for any of these conditions, report 91065 (Breath hydrogen test [e.g., for detection of lactase deficiency], fructose intolerance, bacterial overgrowth, or orocecal gastrointestinal transit) for the test.

Example: A patient with chronic diarrhea reports for a hydrogen breath test. On the claim, you should report 91065 for the test and attach ICD-9 code 787.91 (Diarrhea) to 91065 to represent the patient's diarrhea.

Remember: 91065 should not be used to report an H. pylori breath test analysis. Report those with:
   83013 - Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (e.g., C-13) or
   78268 - Urea breath test, C-14 (isotopic); analysis.