Gastroenterology Coding Alert

Question: My gastroenterologist performs a hydrogen breath test for fructose intolerance. What CPT should I use to report the procedure?

Nevada Subscriber

Answer: For any of these conditions: fructose intolerance, bacterial overgrowth, or orocecal gastrointestinal transit, you may report 91065 (Breath hydrogen test [e.g., for detection of lactase deficiency], fructose intolerance, bacterial overgrowth, or orocecal gastrointestinal transit).

Remember, 91065 is exclusive to the conditions listed in the code description, and doesn't include H. pylori breath test analysis.

Quick fact: Prior to 2005, you could code for the breath hydrogen test only when testing for a lactase deficiency, but the AMA amended the code so you could also report it when testing for other conditions. "Hydrogen breath testing has been an established test for measuring gastrointestinal function for more than 20 years... Due to the type of sample used for this procedure, [91065] may now be used to report breath hydrogen testing for other disorders as well," according to CPT Changes:An Insider's View 2005.

"Since measurement of orocecal transit is useful in detecting motor disorders involving the stomach and small bowel such as diabetic gastroparesis, pseudo-obstruction secondary to scleroderma, diabetes or dumping syndromes, it is of use in patients with unexplained bloating and distension, diarrhea or constipation, nausea and vomiting and abdominal pain," adds CPT Changes.

--Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel.