Procedure and Analysis Determine H. Pylori Reporting
Published on Fri Mar 01, 2002
Revisions over the past two years to various CPT codes for H. pylori testing have created both confusion and challenges for gastroenterology coders. Depending on the gastroenterologist's preference and the patient's medical condition, coders need to know an array of codes in different sections of the CPT manual for accurate reporting and reimbursement of H. pylori testing.
Report C-14 Breath Test with 78267-78268
The C-14 breath test is administered by giving the patient a capsule containing carbon-urea with a low dosage of a radioactive material. If H. pylori is present, it breaks down the urea into carbon dioxide, which is then exhaled and can be measured in the patient's breath. Ten minutes later, the patient provides a breath sample for analysis by blowing up a balloon. The sample can be sent to a testing laboratory, or the gastroenterologist can perform the analysis in-office using equipment called a liquid scintillation counter.
Administration of the C-14 breath test is reported with 78267 (Urea breath test, C-14; acquisition for analysis). If the gastroenterologist also performs the breath analysis, he or she uses 78268 ( analysis) for that step. If the breath sample is sent out for analysis, the laboratory reports the service with 78268.
But there are a few catches to coding for the microCOUNT analysis. Judy Burnett has nearly 20 years experience in gastroenterology coding, most of it with Asheville Gastroenterology in Asheville, N.C. Her practice installed the equipment as a convenience for patients.
"We use 78267 for administration of the test and 78268 for the analysis," Burnett says. "But we have to be careful with Medicare, because in our state we can't bill the breath test on the same day as the office visit. And with Medicaid, we can't have the test and the reading on the same day. As long as we're careful with those situations, we don't have any trouble with reimbursement."
Non-Radioactive Testing
Several revisions to CPT codes 83013 and 83014 in the past two years have broadened their usage. Code 83013 is defined as Helicobacter pylori; analysis for urease activity, non-radioactive isotope. Code 83014 is used to report the drug administration and sample collection.
References to breath specimens and mass spectrometry have been removed from the definition for 83013. These changes were made to allow the reporting of other methods that use the non-radioactive technology of the C-13 breath test, according to Joel V. Brill, MD, a gastroenterologist in Phoenix who is the American Gastroenterological Association representative to the CPT editorial advisory committee and the resource-based relative value scale (RBRVS) update committee.
"CPT codes 83013 and 83014 are used for H. pylori diagnostic tests, such as breath and blood specimens, that are based on C-13 technology for diagnosis," Brill [...]
