Radiology Coding Alert

Question: One of our physicians documented "urea breath testing." How should we report this service?

Kentucky Subscriber Answer: Nuclear medicine specialists often perform urea breath tests to identify helicobacter pylori (H. pylori) infections of the stomach and duodenum (for example, 041.86, Other specified bacterial infections; helicobacter pylori [H. pylori]; and 533.30, Peptic ulcer, site unspecified; acute without mention of hemorrhage and perforation, without mention of obstruction).

CPT designates codes 78267 (Urea breath test, C-14; acquisition for analysis) and 78268 (... analysis) to describe one method of testing. Because of its radioactive nature, you must conduct C-14 analysis in a nuclear medicine or radiology lab. CPT notes that this method requires drug administration and specimen collection, as well as analysis.

The AMA structured the codes to provide individual reporting mechanisms for either acquisition and analysis (78267, Urea breath test, C-14; acquisition for analysis) or analysis only (78268, ... analysis).

Suppose an internist suspects peptic ulcer disease and refers his patient to a gastroenterologist. The GI specialist orders a carbon-14 urea breath test and collects the sample in her office. She then sends the specimen to a radiology lab for analysis. The radiologist reports 78268 because he performed the analysis only.

Alternatively, the GI refers the patient to a radiology practice, where the nuclear radiologist both acquires the sample and conducts the analysis. While the gastroenterologist reports the patient's office visit, the radiologist reports 78267 to represent both the acquisition of the specimen and the analysis.

According to the November 1999 CPT Assistant, you should not report HCPCS A4641 (Supply of radiopharmaceutical diagnostic imaging agent, not otherwise classified) or CPT 78990 (Provision of diagnostic radiopharmaceutical[s]) because the kit that the physician uses to perform the acquisition already includes a radioisotope capsule.