Radiology Coding Alert

The addition of two CPT Codes provides a way to report the urea breath test, a new method of breath testing.

CPT 2000 added two codes for reporting breath tests used to identify helicobacter pylori (H. pylori) infections of the stomach and duodenum (i.e., helicobacter pylori infection, 041.86; peptic ulcer, 533-533.9). The new CPT 78267 (urea breath test, C-14; acquisition for analysis) and 78268 (analysis)are used to report a new method of testing that relies on radioactive isotopes.

The C-14 is an entirely different method of testing, points out Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals, a national billing and management firm for hospital-based physician practices, based in Chattanooga, Tenn. Previously, physicians relied on the C-13 breath test, which was nonradioactive and was measured in a pathology lab. But because of its radioactive nature, C-14 analysis must be conducted in a nuclear medicine or radiology lab.

The carbon-13 test traditionally has been reported with codes 83013 (Helicobacter pylori, breath test analysis [mass spectrometry]) and 83014 (drug administration and sample collection), Hall says.

The old and new sets of codes are similar in structure and use, according to Laurie Castillo, MA, CPC, senior healthcare consultant and owner of Physician Coding & Compliance Consulting of Northern Virginia. CPT notes that both types of methodology require drug administration and specimen collection, as well as analysis. Therefore, the codes have been structured to provide individual reporting mechanisms should either one or both of the procedures be performed, she says, citing the November 1999 CPT Assistant .

The following examples illustrate when the new codes should be reported and who should report them:

Example #1: A family practitioner refers a patient with a suspected diagnosis of peptic ulcer disease (533.0) to a gastroenterologist. The gastroenterologist orders a carbon-14 urea breath test, and the sample is collected in her office. The specimen is then sent to a radiology lab for analysis. The gastroenterologist reports 78267, while the radiologist reports 78268.

Example #2: A family practitioner refers a patient with a suspected diagnosis of peptic ulcer disease to a gastroenterologist. The gastroenterologist orders a carbon-14 urea breath test and refers the patient to a radiology practice. The radiologist acquires the sample and conducts the analysis. The gastroenterologist would code the patients office visit (along with any other applicable codes), while the radiologist would report both 78267 and 78268.

Castillo also notes that the kit for collecting the sample includes the radioactive capsule used for the acquisition. According to the CPT Assistant, radiologists are not allowed to code separately for the provision of the radiopharmaceutical, she says. With other tests, they may add HCPCS A4641 (supply of radiopharmaceutical diagnostic imaging agent, not otherwise classified) or CPT 78990 (provision of diagnostic radiopharmaceutical[s]), but that is not the case when using code 78267. In addition, the kit includes a mailer, so radiologists should not report code 99000 (handling and/or conveyance of specimen for transfer from the physicians office to a laboratory) either."