Gastroenterology Coding Alert

But H. pylori scans will still have separate codes
While additions and deletions of codes are the most significant changes to CPT 2005, the AMA also amended one of its hydrogen breath test codes so you can report it when testing for more varied conditions.

Coders will be able to report breath hydrogen tests  more frequently in 2005 because the existing code will be upgraded to include testing for more conditions. In the past, you could code for the breath hydrogen test only when testing for a lactase deficiency. 

This year, the AMA amended the code so you could also report it when testing for fructose intolerance, bacterial overgrowth, or orocecal gastrointestinal transit.

If your gastro performs a hydrogen breath test to check for any of these conditions, you may report 91065 (Breath hydrogen test [e.g., for detection of lactase deficiency], fructose intolerance, bacterial overgrowth, or orocecal gastrointestinal transit).

Rationale: "Hydrogen breath testing has been an established test for measuring gastrointestinal function for more than 20 years. Prior to this revision, the test ... was only available to test for intolerance using a direct absorption testing through duodenal and jejunal intubation. Due to the type of sample used for this procedure, [91065] may now be used to report breath hydrogen testing for other disorders as well," according to CPT Changes: An Insider's View 2005. Know the Symptoms Before Using 91065 Remember not to report 91065 unless you are testing for one of the conditions listed in the code description.  

"Fructose intolerance is common in patients with unexplained chronic diarrhea, bloating due to gaseousness, and abdominal pain; ... bacterial overgrowth is common in patients with unexplained chronic diarrhea and mal-absorption," CPT Changes: An Insider's View 2005 states.

"Since measurement of orocecal transit is useful in detecting motor disorders involving the stomach and small bowel such as diabetic gastroparesis, pseudo-obstruction secondary to scleroderma, diabetes or dumping syndromes, it is of use in patients with unexplained bloating and distension, diarrhea or constipation, nausea and vomiting and abdominal pain," CPT Changes: An Insider's View 2005 continued.

Remember: "This code [91065] does not include H. pylori breath test analysis," said Robert B. Cameron, MD, FACG, of the American College of Gastroenterology and the AMA/CPT Advisory Committee, while speaking at November's CPT 2005 Coding Symposium in Chicago.

Cameron told coders that in 2005, they should continue to report H. pylori tests with:

  83013 - Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (e.g.,  C-13) or
  78268 - Urea breath test, C-14 (isotopic); analysis.