Helicobacter pylori, Urea Breath Test, Pediatric

Test Code

92491

CPT Codes
83013

Preferred Specimen

Human breath from patients 3-17 years of age: Paired breath samples (pre and post) collected in PyloPlus® UBT Collection Kit bags and must be submitted together

Patient Preparation
Patient should fast at least one hour before collection of baseline breath sample.
Use of antimicrobials, proton pump inhibitors, or bismuth preparations within two weeks prior to administering the PyloPlus® UBT test may cause a false negative result. However, a positive result is still valid.

Insufficient data are available on pregnant and lactating women.

Instructions

This test can only be performed on specimens from patients 3-17 years old.
Patients >17 years of age must use test code 14839-Helicobacter pylori, Urea Breath Test.

Transport Temperature

Room temperature

Specimen Stability

Room temperature: 7 days
Refrigerated: Unacceptable
Frozen: Unacceptable

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

Specimens from patients <3 years old • Insufficient breath for analysis • Single collection bags • Specimens not submitted in PyloPlus® UBT collection bags • Uncapped bags

Methodology
Infra-red Spectrophotometry (IR)

Setup Schedule

Set up: Tues-Sat; Report available: 1-3 days

Reference Range

Not detected

The performance characteristics of this test when performed on persons under the age of 3 have not been established.

Clinical Significance

Helicobacter pylori is a gram-negative microaerophilic curved bacillus with an affinity for human gastric mucosa. H. pylori has been identified as an important pathogen in the upper GI tract. The causal relationship between H. pylori and chronic active gastritis, duodenal ulcers, and gastric ulcers has been well documented. PyloPlus UBT breath tests provide a non-invasive and non-hazardous method for detecting current H. pylori infection using urea breath analysis.

Performing Laboratory
Quest Diagnostics Nichols Institute
14225 Newbrook Drive
Chantilly, VA 20153

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.