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.

North Carolina Subscriber

Answer: The parameters governing hydrogen breath tests have changed over time, and gastroenterologists can get paid for lactase deficiency checks in addition to several other conditions. For instance, in CPT 2005, the AMA 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]).
Example: A patient with chronic diarrhea reports for a hydrogen breath test. On the claim, you should report 91065 for the test and attach 787.91 (Diarrhea) to 91065 to represent the patient's diarrhea.

Remember: You should not use 91065 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.