Differentiate Source, Procedure for Helicobactor Pylori Tests
Published on Thu Nov 01, 2001
Diagnosis of peptic ulcer disease (PUD, 533.x) and certain other gastric disorders is often linked to the presence of Helicobactor pylori, a urease-producing bacterium. Myriad procedures identify the organism, and they are scattered throughout the pathology section and elsewhere in the CPT manual . Correctly reporting these services depends on an understanding of the laboratory procedure involved and the source of the specimen for testing.
Various tests for H. pylori may be ordered to aid in the diagnosis of PUD and, in some cases, to follow the effectiveness of treatment. "Because lab methods and codes for these tests have been changing in recent years, coders need to be aware of the changes and the coverage issues involved," says William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, laboratory coding and compliance consultants in Longwood, Fla. Through Correct Coding Initiative (CCI) edits and local medical review policies (LMRPs), Medicare defines coverage and frequency limitations of H. pylori tests for diagnostic or post-treatment purposes and restricts payment for multiple tests for the same patient.
Serologic Antibody Tests
"Antibody tests carried out on blood samples provide an immunologic method for primary diagnosis of H. pylori infection," Dettwyler says. However, these markers are not indicated for post-treatment evaluation because the antibodies remain in the blood for a year or more follow-ing an active infection. "There are two codes for H. pylori antibody, based on the complexity of the lab method involved," Dettwyler says.
The test coded with 86318 (immunoassay for infectious agent antibody, qualitative or semiquantitative, single-step method [e.g., reagent strip]) is commonly used in physician office labs to provide a rapid, qualitative detection of IgG antibodies for H. pylori in the blood. "Laboratories operating under a Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver can conduct this test and should report the code with modifier -QW (CLIA-waived test)," Dettwyler says.
CPT states that codes in the family 86677 (antibody; Helicobactor pylori) represent "qualitative or semiquantitative immunoassays performed by multiple-step methods for the detection of antibodies to infectious agents." The distinguishing characteristic for this code is "multiple step" rather than a single-step method described by 86318, Dettwyler says.
Biopsy Culture and Histology
When a patient's condition warrants, an endoscopic gastric biopsy may be conducted. "Several tests might be carried out directly on the biopsy tissue, as well as on cultures grown from the specimen," says Leah J. Barrett, BS, MT (ASCP), assistant director of the University of Virginia Center for Studies of Diseases Due to H. pylori, in Charlottesville, Va.
"We typically process a Gram stain smear directly from the biopsy [...]
