For Members:
- What is H.pylori Infection?
H.Pylori is a Bacterial infection which grows in the stomach and causes mild to severe acidity. If not treated adequately in a timely manner, it can lead to serious conditions like ulcers and stomach cancer. The infection is more common in adults then in children.
- What are the Signs & Symptoms?
- Burning pain in your stomach.
- Pain and cramping near stomach.
- Increasing in pain and cramping when your stomach is empty.
- Loss of appetite.
- Frequent burping.
- Unplanned weight loss.
- Mild chest pain without shortness of breath.
- How diagnosis is made?
- For an infected person, the Bacteria is found in stool, saliva, and dental plaque. Samples can be collected from these locations and the bacteria can be cultured.
- Your Physician will request a breath test or stool test to confirm the infection.
- Your treating Physician may recommend to repeat the testing for H. pylori at least four (4) weeks after the treatment. If the test is still positive, it shows that the treatment was unsuccessful, you may undergo another round of treatment and your physician probably prescribe different medications.
- How is the infection transmitted or spreads?
The infection can be transferred from person-to-person, through oral-oral or fecal-oral route. If you or a family member is infected with H.Pylori, then chances of acquiring the infection are higher among the family members.
For Healthcare Providers:
Below is the list of CPT codes related to diagnosis and follow-up on H.Pylori Infection:
| Laboratory Test |
CPT |
Clinical Uses |
| Urea Breath Test* |
83014
83013 |
H. pylori at least four weeks after the treatment. |
| H.pylori stool antigen |
87338 |
Medically necessary for testing for active Helicobacter pylori |
| Urea breath test, C-14/C-13 |
78267 |
Used to follow-up on already diagnosed patients |
| H. pylori, blood test |
83009 |
Not approved (experimental) |
* Report 83013 for the breath test analysis and 83014 for the isotope administration and sample collection.
Recommendations:
- Initial diagnosis of H. pylori infection be based on either a positive histopathology plus a positive rapid urease test or a positive culture.
- The 13C-urea breath test (UBT) is a reliable noninvasive test to determine whether H. pylori has been eradicated.
- A validated enzyme-linked immunosorbent assay (ELISA) test for detection of H pylori antigen in stool is a reliable noninvasive test to determine whether H pylori has been eradicated.
- Persons or patients with no gastrointestinal symptoms:
- a history of peptic ulcer without previous H. pylori eradication (including before taking NSAIDs or low-dose aspirin); or
- with immunological thrombocytopenic purpura.
- Carbon isotope (13C or 14C) urea breath testing or stool antigen testing are medically necessary for the testing for active Helicobacter pylori infection in selected persons who meet any of the following criteria:
- Evaluation of new onset dyspepsia in persons younger than 55 years of age without alarm symptoms (anemia, weight loss, vomiting, lymphadenopathy); or
- Evaluation of persons with persistent symptoms of dyspepsia despite 2 weeks of appropriate antibiotic therapy for Helicobacter pylori (H. pylori); or
- Before starting proton pump inhibitor therapy for dyspepsia; or
- Unexplained vitamin B12 deficiency; or
- immunological thrombocytopenic purpura; or
- Recurrent dyspeptic symptoms suggesting re-infection with H. pylori; or
- Re-evaluation to assess success of eradication of H. pylori infection. (Note: Testing to ensure eradication should occur no sooner than 4 weeks post-treatment).
- pylori serology is considered experimental because of its inadequate performance. (procedure codes 83009 86677, 87339).
References:
