Gastroenterology Coding Alert

Question: Our gastroenterologist recently saw an established patient with prolonged acidity and stomach pain. He ordered a C-14 breath test. We conducted the test and the physician analyzed the test himself. How should I code this visit? What is the purpose of the test? What if we send the sample to a lab?

New York Subscriber

Answer: You can report the administration of the C-14 breath test with code 78267 (Urea breath test, C-14 (isotopic); acquisition for analysis). As the physician analyzed the test in your office, you can code the analysis with 78268 (Urea breath test, C-14(isotopic); analysis). However, you should check with your payer regarding the rules of payment for both the test. Some payers will not accept the breath test and the analysis separately if they are conducted on the same day.

Gastroenterologists opt for this test when they suspect H. pylori infection. Helicobacter pylori or H. pylori is a bacterium usually associated with stomach infection, and may cause ulcers or stomach cancer. This bacterium can grow in the stomach and, occasionally, the duodenum. Its presence irritates these areas and can lead to gastritis and peptic ulcer disease.

The physician administers a radioactive isotope C-14 labeled solution or capsule of urea to the patient orally. If H. pylori is present, it breaks down the urea into carbon dioxide. The test provider then uses a liquid scintillation counter to measure the level of carbon dioxide in the breath samples and analyze them for the presence of infection in the stomach.

Report the office visit by choosing from the E/M code range 99211-99215 for established patients depending upon the parameters fulfilled by your GI.

Tip: If the gastroenterologist’s office does not have analysis facilities, you will only report the collection of sample with 78267 and the laboratory bills for the analysis.