Radiology Coding Alert

Question: Our nuclear radiologist provides urea breath testing. Can you tell me what this is and how I should code for it?

Montana Subscriber

Answer: Urea breath tests represent a category of breath assessments that identify helicobacter pylori (H. pylori) infections of the stomach and duodenum (e.g., 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 78267 (Urea breath test, C-14; acquisition for analysis) and 78268 ( analysis) are used to describe one method of testing. But because of its radioactive nature, C-14 analysis must be conducted in a nuclear medicine or radiology lab. CPT notes that this method requires drug administration and specimen collection, as well as analysis. Therefore, the codes have been structured to provide individual reporting mechanisms for either acquisition and analysis or analysis only (which a physician performs).

For instance, 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 the sample is collected in her office. The specimen is sent to a radiology lab for analysis. The radiologist reports 78268 because only the analysis was performed. There is no separate code for sample collection. 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.

Payment for these codes covers the cost of the kit used to collect the sample, including the radioactive capsule used for the acquisition. Therefore, radiology coders should not report HCPCS A4641 (Supply of radiopharma-ceutical diagnostic imaging agent, not otherwise classified) or CPT 78990 (Provision of diagnostic radiopharmaceutical[s]) as they may with certain other services. And the kit includes a mailer, so radiologists should not report code 99000 either (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory).

In the past, physicians relied on the C-13 breath test (83013, Helicobacter pylori; analysis for urease activity, nonradioactive isotope; and 83014, drug administration and sample collection), which was nonradioactive and therefore measured in a pathology lab.