Monday, May 16, 2016

Helicobacter Pylori (H. pylori]) Testing ICD-10 - B96.81 - CPT 78267, 78268 Covered Indications

Code Description

B96.81 Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere
C16.0 Malignant neoplasm of cardia
C16.1 Malignant neoplasm of fundus of stomach
C16.2 Malignant neoplasm of body of stomach
C16.3 Malignant neoplasm of pyloric antrum
C16.4 Malignant neoplasm of pylorus
C16.5 Malignant neoplasm of lesser curvature of stomach, unspecified
C16.6 Malignant neoplasm of greater curvature of stomach, unspecified
C16.8 Malignant neoplasm of overlapping sites of stomach
C16.9 Malignant neoplasm of stomach, unspecified
C82.50 Diffuse follicle center lymphoma, unspecified site
C82.59 Diffuse follicle center lymphoma, extranodal and solid organ sites
C83.80 Other non-follicular lymphoma, unspecified site
C83.81 Other non-follicular lymphoma, lymph nodes of head, face, and neck
C83.82 Other non-follicular lymphoma, intrathoracic lymph nodes
C83.83 Other non-follicular lymphoma, intra-abdominal lymph nodes
C83.84 Other non-follicular lymphoma, lymph nodes of axilla and upper limb
C83.85 Other non-follicular lymphoma, lymph nodes of inguinal region and lower
C83.86 Other non-follicular lymphoma, intrapelvic lymph nodes
C83.87 Other non-follicular lymphoma, spleen
C83.88 Other non-follicular lymphoma, lymph nodes of multiple sites
C83.89 Other non-follicular lymphoma, extranodal and solid organ sites
C84.90 Mature T/NK-cell lymphomas, unspecified, unspecified site
C84.99 Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ sites
C84.A0 Cutaneous T-cell lymphoma, unspecified, unspecified site
C84.A9 Cutaneous T-cell lymphoma, unspecified, extranodal and solid organ sites
C84.Z0 Other mature T/NK-cell lymphomas, unspecified site
C84.Z9 Other mature T/NK-cell lymphomas, extranodal and solid organ sites
C85.10 Unspecified B-cell lymphoma, unspecified site
C85.19 Unspecified B-cell lymphoma, extranodal and solid organ sites
C85.20 Mediastinal (thymic) large B-cell lymphoma, unspecified site
C85.29 Mediastinal (thymic) large B-cell lymphoma, extranodal and solid organ sites
C85.80 Other specified types of non-Hodgkin lymphoma, unspecified site
C85.89 Other specified types of non-Hodgkin lymphoma, extranodal and solid organ
C85.90 Non-Hodgkin lymphoma, unspecified, unspecified site
C85.99 Non-Hodgkin lymphoma, unspecified, extranodal and solid organ sites
C86.4 Blastic NK-cell lymphoma
C88.4 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid
K25.0 Acute gastric ulcer with hemorrhage
K25.1 Acute gastric ulcer with perforation
K25.2 Acute gastric ulcer with both hemorrhage and perforation
K25.3 Acute gastric ulcer without hemorrhage or perforation
K25.4 Chronic or unspecified gastric ulcer with hemorrhage
K25.5 Chronic or unspecified gastric ulcer with perforation
K25.6 Chronic or unspecified gastric ulcer with both hemorrhage and perforation
K25.7 Chronic gastric ulcer without hemorrhage or perforation
K25.9 Gastric ulcer, unspecified as acute or chronic, without hemorrhage or
K26.0 Acute duodenal ulcer with hemorrhage
K26.1 Acute duodenal ulcer with perforation
K26.2 Acute duodenal ulcer with both hemorrhage and perforation
K26.3 Acute duodenal ulcer without hemorrhage or perforation


 Code Description
K26.4 Chronic or unspecified duodenal ulcer with hemorrhage
K26.5 Chronic or unspecified duodenal ulcer with perforation
K26.6 Chronic or unspecified duodenal ulcer with both hemorrhage and perforation
K26.7 Chronic duodenal ulcer without hemorrhage or perforation
K26.9 Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or
K27.0 Acute peptic ulcer, site unspecified, with hemorrhage
K27.1 Acute peptic ulcer, site unspecified, with perforation
K27.2 Acute peptic ulcer, site unspecified, with both hemorrhage and perforation
K27.3 Acute peptic ulcer, site unspecified, without hemorrhage or perforation
K27.4 Chronic or unspecified peptic ulcer, site unspecified, with hemorrhage
K27.5 Chronic or unspecified peptic ulcer, site unspecified, with perforation
K27.6 Chronic or unspecified peptic ulcer, site unspecified, with both hemorrhage
K27.7 Chronic peptic ulcer, site unspecified, without hemorrhage or perforation
K27.9 Peptic ulcer, site unspecified, unspecified as acute or chronic, without
K28.0 Acute gastrojejunal ulcer with hemorrhage
K28.1 Acute gastrojejunal ulcer with perforation
K28.2 Acute gastrojejunal ulcer with both hemorrhage and perforation
K28.3 Acute gastrojejunal ulcer without hemorrhage or perforation
K28.4 Chronic or unspecified gastrojejunal ulcer with hemorrhage
K28.5 Chronic or unspecified gastrojejunal ulcer with perforation
K28.6 Chronic or unspecified gastrojejunal ulcer with both hemorrhage and
K28.7 Chronic gastrojejunal ulcer without hemorrhage or perforation
K28.9 Gastrojejunal ulcer, unspecified as acute or chronic, without hemorrhage or
K29.00 Acute gastritis without bleeding
K29.01 Acute gastritis with bleeding
K29.30 Chronic superficial gastritis without bleeding
K29.31 Chronic superficial gastritis with bleeding
K29.40 Chronic atrophic gastritis without bleeding
K29.41 Chronic atrophic gastritis with bleeding
K29.50 Unspecified chronic gastritis without bleeding
K29.51 Unspecified chronic gastritis with bleeding
K29.60 Other gastritis without bleeding
K29.61 Other gastritis with bleeding
K29.70 Gastritis, unspecified, without bleeding
K29.71 Gastritis, unspecified, with bleeding
K29.80 Duodenitis without bleeding
K29.81 Duodenitis with bleeding
K29.90 Gastroduodenitis, unspecified, without bleeding
K29.91 Gastroduodenitis, unspecified, with bleeding
K30 Functional dyspepsia
K52.89 Other specified noninfective gastroenteritis and colitis
K52.9 Noninfective gastroenteritis and colitis, unspecified
R10.11 Right upper quadrant pain
R10.12 Left upper quadrant pain
R10.13 Epigastric pain
R10.84 Generalized abdominal pain
Z87.11 Personal history of peptic ulcer disease



CPT Description

78267 Urea breath test, C-14 (isotopic); acquisition for analysis
78268 Urea breath test, C-14 (isotopic); analysis
83009 Helicobacter pylori, blood test analysis for urease activity, non-radioactive isotope (eg, C-13)
83013 Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)
83014 Helicobacter pylori; drug administration
86677 Antibody; helicobacter pylori
87338 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiplestep method; helicobacter pylori, stool
87339 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiplestep method; helicobacter pylori

Related coding—Upper gastrointestinal endoscopy with biopsy codes and not otherwise classified diagnostic radiopharmaceuticals that deny when helicobacter pylori (H. pylori) testing is denied for a non covered indication:

43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple
A4641 Radiopharmaceutical, diagnostic, not otherwise classified


BACKGROUND

Helicobacter pylori (H. pylori) is a gram-negative rod bacteria that is uniquely adapted to survive in the highly acidic gastric environment. To survive in the harsh, acidic environment of the stomach, H. pylori secretes an enzyme called urease, which converts the chemical urea to ammonia.The production of ammonia around H.pylori neutralizes the acidity of the stomach, making it more hospitable for the bacterium. In addition, the shape of H. pylori allows it to burrow into the mucus layer, which is less acidic than the lumen of the stomach. H. pylori can also attach to the cells that line the inner surface of the stomach.


H. pylori infection with the bacterium is common. The Centers for Disease Control and Prevention (CDC) estimates that approximately two-thirds of the world’s population harbors the bacterium, with infection rates much higher in developing countries than in developed nations.


Diagnosis

According to the American College of Gastroenterology, the established indications for diagnosis and treatment of H. pylori are:

 Active peptic ulcer disease (gastric or duodenal ulcer)
 Confirmed history of peptic ulcer disease (not previously treated for H. pylori infection)
 Gastric MALT lymphoma (low grade)
 After endoscopic resection of early gastric cancer
 Uninvestigated dyspepsia (depending upon H. pylori prevalence) - Test and treat strategy, especially for those under 55 who have no alarm features.


Alarm features identified by the College of Gastroenterology include bleeding, anemia, early satiety, unexplained weight loss, progressive dysphagia, odynophagia, recurrent vomiting, family history of GI cancer, and previous esophagogastric malignancy

It is not necessary to perform H. pylori testing in the following situations:

 In the absence of documented gastritis or duodenal pathology (i.e. Patients who have had a normal upper GI endoscopy within the preceding six weeks).
 Patients for whom an upper GI endoscopy is planned either for initial diagnosis or follow-up.
 Patients who are asymptomatic after treatment of H. pylori infection, unless there is a documented family history of gastric cancer or it is necessary to resume NSAIDS or ulcerogenic mediations.
 Patients with dyspepsia requiring endoscopy and biopsy or to monitor response to therapy.
 Patients with new onset, uncomplicated dyspeptic symptoms.


Testing

Testing for H. pylori can be divided into invasive specimen collection (biopsy and/or culture), non-invasive specimen collection (gram stain, rapid urease testing, serologic tests, breath tests) and assay for stool antigens (HpSA). The choice of specific testing depends on the clinical presentation of the patient and whether or not the patient requires endoscopy for evaluation. When medically necessary, more than one test may be needed to achieve the best diagnostic accuracy.


Invasive Tests

Invasive tests for H. pylori detection involve endoscopic biopsies of stomach tissue. Esophagogastroduodenoscopy (EGD) is used to obtain specimens of gastric mucosa. If endoscopy is indicated for the clinical evaluation of the patient, collection of biopsy specimens for histologic examination, urease activity and/or culture may be considered.

Non-Invasive Tests

Non-Invasive Specimen Collection (blood, breath, stool, etc) do not require endoscopy and are generally serological qualitative or semi-quantitative tests. The urea breath test or stool test is recommended for initial testing for H. pylori because they are non-invasive, accurate and cost-effective. Although the serological test for H. pylori antigen is non-invasive and cost-effective, it is not recommended for initial evaluation or for determination of eradication after treatment for H. pylori according to the American College of Gastroenterology.

Serological testing may be appropriate for the patient with non-specific dyspeptic symptoms in order to rule in or out H. Pylori infection. This test is not appropriate to determine treatment outcome because the test is limited to the detection of antibodies and therefore cannot accurately detect active infection because high levels of antibodies persist for months after treatment. Serology is not used for follow-up testing or to determine cure.

Urea Breath Test

The urea breath test for is a non-invasive diagnostic procedure utilizing analysis of breath samples to determine the presence of H. pylori in the stomach. The H. pylori breath test consists of analysis of breath samples before and after ingestion of labeled C-urea. Breath tests can detect the continued presence of H. pylori  After treatment, (which is not the case with serology, where the presence of antibodies can exist for long periods of time).

Urea Breath Tests are indicated in patients who:

 Continue to have symptoms of dyspepsia after completing a treatment regimen which includes appropriate antibodies and no endoscopy is planned.
 Have symptoms that continue four weeks after the treatment regimen has been completed.
 Patients that have a history of hemorrhage, or outlet obstruction from peptic ulcer disease.
 Patients with a history of ulcer on chronic NSAID or on anticoagulant therapy.


Breath tests are not considered medically necessary for patients who are being screened for H. pylori infection  in the absence of documented upper gastrointestinal tract symptoms and/or pathology, patients who have had upper gastrointestinal endoscopy within the preceding six weeks or for whom an upper gastrointestinal endoscopy is planned, patients who have non-specific dyspeptic symptoms with a negative H. Pylori serum antibody test, or patients who are asymptomatic after treatment of an H. pylori infection (either proven or suspected).

Stool Testing

The stool test describes an in vitro qualitative procedure for the detection of H. pylori antigens in human stool. A fresh or appropriately stored stool specimen is processed and tested by enzyme immunoassay technique. Test results can aid in the diagnosis of H. pylori as well as response to therapy. The stool test is appropriate for the patient with non-specific dyspeptic symptoms. In contrast to the serum antibody test, the stool antigen test returns to normal (negative) after successful treatment, and may determine treatment outcome. Indications for stool antigen testing include the initial detection of H. pylori and follow-up of patients who continue to have symptoms after completing a treatment regimen that includes appropriate antibiotics. The stool test for H. pylori antigen is also appropriate for the patient with non-specific dyspeptic symptoms. In contrast to the serum antibody test, the stool antigen test returns to normal (negative) after successful treatment, and may be used to determine treatment outcome and whether eradication has occurred.

Serological Testing

Serological testing for antibodies to H. pylori is inexpensive, convenient and simple, but, because antibody levels persist some months after treatment, it is not useful for assessing therapeutic effectiveness.

Confirmation of successful H pylori cure may be necessary:
 In Patients with an H. pylori-associated ulcer
 Individuals with persistent dyspeptic symptoms despite the test-and –treat strategy
 Those with H. pylori-associated MALT lymphoma
 Individuals who have undergone resection of early gastric cancer

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