Can’t Locate an H. Pylori Lab Test Code? 2 Clues Point the Way

Posted on 04. Oct, 2009 by Editor in Hot Coding Topics

Electron Microscope Photo: Yutaka Tsutsumi, M.D.

Solve CLO test culture code dilemma and other mysteries.

With numerous Helicobacter pylori lab tests scattered throughout the CPT pathology/laboratory section and beyond, you might need some help finding the right code. In breath, blood, biopsy, or stool, numerous tests help physicians track down signs of H. pylori infection that can lead to peptic ulcer disease. Our experts break down your coding choices and show that your selection primarily depends on lab method and specimen source.

Find Urease Activity in Breath and Blood

H. pylori produces an enzyme called urease that neutralizes stomach acid and enables the bacteria to thrive in the gut. Clinicians have turned this feature into a handy test platform – find the urease and you’ve found an indication of H. pylori.

• For urease activity in blood specimens, report 83009 (Helicobacter pylori, blood test analysis for urease activity, non-radioactive isotope [e.g., C-13]).

For urease activity in breath specimens, you have two choices based on the carbon isotope used for testing. Both C-14 (radioactive carbon) and C-13 (heavy carbon) tests require the patient to ingest urea, which H. pylori metabolizes into exhaled CO2 that the lab then measures.

• C-14 breath test: You should report the administration of the C-14 breath test with 78267 (Urea breath test, C-14 [isotopic]; acquisition for analysis). For the laboratory breath analysis using a liquid scintillation counter to quantify the C-14 present in exhaled breath, you should report 78268 (… analysis).

Don’t forget: If your lab provides the radioactive isotope for this procedure, you should include A4641 (Radiopharmaceutical, diagnostic, not otherwise classified).

• C-13 breath test: You should use 83014 (Helicobacter pylori; drug administration) and 83013 (Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope [e.g., C-13]) for H. pylori breath test based on C-13 technology for diagnosis, says Joel V. Brill, MD, AGAF, chief medical officer at Predictive Health LLC in Phoenix. The lab detects the amount of C-13 in the exhaled breath specimen using a method such as mass spectrometry.

Zero In on Serologic Antibodies

Blood antibody tests provide an immunologic method to diagnose H. pylori infection. “Two codes describe serologic H. pylori antibody tests based on the complexity of the lab method,” says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Choose the code based on the complexity of the lab method as follows:

• 86318 — Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step method (e.g., reagent strip).

Physician office labs commonly use this test to provide a rapid, qualitative detection of IgG antibodies for H. pylori in the blood. Laboratories operating under a Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver can conduct this test and should report the code with modifier QW (CLIA-waived test). CLIA lists 28 test kits approved for this code.

• 86677 (Antibody; Helicobacter pylori).

Multiple step is key: According to CPT instruction, tests in this family “are qualitative or semiquantitative immunoassays performed by multiple-step methods for the detection of antibodies to infectious agents.”

“The distinguishing characteristic for this code is ‘multiple step’ rather than a single-step method…

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Tags: 78267, 78268, 83009, 83014, 86318, 86677, 87077, 87338, 87339, A4641, clinical lab, CLO, H. pylori, modifier QW