Gastroenterology Coding Alert

Question: How do we code for H. pylori tests?

Codify Subscriber

Answer: The answer to this question depends on whether your physician performed a breath test or a biopsy.

The breath tests are a non-invasive method of detecting the presence of H. pylori, the bacteria responsible for causing gastric, peptic, and duodenal ulcers. There are two types of breath tests: the carbon-13 (C-13) and carbon-14 (C-14) versions.

With the C-13 breath test, a baseline breath sample is taken from the patient and then liquid C-13 is given to the patient to swallow. Approximately 30 minutes later, another breath sample is taken and can be analyzed at your office or sent to a laboratory for analysis.

The C-14 breath test is given as a capsule that contains a low dosage of a radioactive isotope. The patient gives a breath sample by blowing into a balloon 10 minutes after ingesting the capsule. The sample can be sent to a laboratory for analysis, or the gastroenterologist can perform an analysis in his or her office by using a device called a liquid scintillation counter. With both test versions, the gastroenterologist will get a positive, negative or indeterminate result back from the laboratory analysis, and no further interpretation of the test needs to be done.

Admin: To report the administration of C-13 test, you should bill code 83014 (Helicobacter pylori; drug administration) to report the administration of the test. To report the administration of the C-14 breath test in your facility you have 78267 (Urea breath test, C-14[isotopic]; acquisition for analysis).

Analysis: The laboratory or physician that does the analysis of the C-14 breath sample should report code 78268 (Urea breath test, C-14[isotopic]; analysis). The facility performing the analysis of the C-13 sample should report code 83013 (Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope [e.g.,C-13]).

If the gastroenterologist performs both the administration and analysis of the tests, then he or she would report both codes depending on which test is performed.

The urea breath test is cleared by the FDA only for use in adults (18 years of age and older), so the gastroenterologist may perform stool antigen testing for pediatric patients, which is billable using 87338 (Infectious agent antigen detection by immunoassay technique, [eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool]).

Another method for confirming the H. pylori infection is through endoscopy with biopsy, often used in patients older than 55 years of age and younger patients with alarm symptoms (e.g., weight loss, progressive dysphagia, recurrent vomiting, evidence of gastrointestinal bleeding, or family history of upper gastrointestinal cancer). If your gastroenterologist performs this procedure, you can report it with 43239 (Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple).