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Breath hydrogen/lactose. 91065

Debby Posted Wed 18th of April, 2012 11:32:10 AM

We are having problems getting paid from Medicare on 91065 it seems the only icd 9 they are will to accept is

SuperCoder Answered Wed 18th of April, 2012 12:11:04 PM

Gastroenterology Coding Alert April 2008 says:

Question: When a gastroenterologist performs a hydrogen breath test, what are some acceptable conditions to test for? I thought the test was only used to check for a lactase deficiency.
North Carolina Subscriber
Answer: The parameters governing hydrogen breath tests have changed over time, and gastroenterologists can get paid for lactase deficiency checks in addition to several other conditions. For instance, in CPT 2005, the AMA amended hydrogen breath test rules to include testing for fructose intolerance, bacterial overgrowth, or orocecal gastrointestinal transit.
Whenever a gastroenterologist performs a hydrogen breath test to check for any of these conditions, report 91065 (Breath hydrogen test [e.g., for detection of lactase deficiency, fructose intolerance, bacterial overgrowth, or orocecal gastrointestinal transit]).
Example: A patient with chronic diarrhea reports for a hydrogen breath test. On the claim, you should report 91065 for the test and attach 787.91 (Diarrhea) to 91065 to represent the patient’s diarrhea.
Remember: You should not use 91065 to report an H. pylori breath test analysis. Report those 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

The following breath tests are excluded from coverage:

Lactulose breath hydrogen for diagnosing small bowel bacterial overgrowth and measuring small bowel transit time.

22 CO 2 for diagnosing bile acid malabsorption
22 CO 2 for diagnosing fat malabsorption

Screening tests, in the absence of associated signs, symptoms or complaints are denied under 1862(a)(7).

It is understood that any diagnosis information submitted must have (in the patient record) medical justification of the tests. Subsequent determination that the medical record is lacking such justification will result in a retroactive denial under 1862(a)(1)(A).
Documentation Requirements

The ordering physician should retain in the patient's medical record, history and physical, examination notes documenting evaluation and management of one of the Medicare covered conditions/diagnoses, with relevant clinical signs/symptoms or abnormal laboratory test results, appropriate to one of the covered indications. The patient's clinical record should further indicate changes/alterations in medications prescribed for the treatment of the patient's condition. There must be an attending/treating physician's order for each test documented in the patient's medical/clinical record. Documentation must be available to Medicare upon request.
ICD-9 Codes that Support Medical Necessity

271.3 Intestinal disaccharidase deficiencies and disaccharide malabsorption

787.91 Diarrhea

Lisa d Answered Wed 18th of April, 2012 14:49:15 PM

You may use 787.3, 008.5 or 789.00.. Remember the 25 modifier when billing with an office visit or they will bundle it.

SuperCoder Answered Wed 18th of April, 2012 14:53:14 PM

Thanks for adding this info for Debby.

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