Which ICD‑10‑CM code should be used to bill a follow‑up visit for confirming H. pylori eradication after completing treatment?

ICD-10-CM Coding for H. pylori Post-Treatment Testing

Use ICD-10 code Z87.19 (Personal history of other diseases of the digestive system) for billing follow-up H. pylori eradication testing after treatment completion. This code appropriately captures the clinical scenario of confirming eradication in a patient with a history of treated H. pylori infection.

Primary Diagnosis Code for Test of Cure

• Z87.19 is the most appropriate code for post-treatment H. pylori testing, as it documents the personal history of digestive system disease requiring follow-up confirmation 1, 2
• This code supports medical necessity for non-invasive testing (urea breath test or stool antigen test) performed at least 4 weeks after treatment completion 1, 2

Alternative Codes Based on Clinical Context

If the patient has specific ongoing conditions that prompted H. pylori treatment, use these codes as primary or secondary diagnoses:

• K27.9 (Peptic ulcer, unspecified as acute or chronic, without hemorrhage or perforation) - for patients with peptic ulcer disease history requiring eradication confirmation 3
• K29.70 (Gastritis, unspecified, without bleeding) - for patients treated for H. pylori-associated gastritis 3
• K31.89 (Other diseases of stomach and duodenum) - can be used for H. pylori-related gastric pathology 3
• R10.13 (Epigastric pain) - if patient has persistent dyspepsia symptoms requiring eradication confirmation 3

When Test of Cure is Mandatory (Strongest Billing Justification)

These clinical scenarios provide the strongest medical necessity for billing post-treatment testing:

• Gastric ulcer - requires endoscopic follow-up and confirmed eradication; use K25.9 as primary code 1, 2
• Complicated peptic ulcer disease - including bleeding ulcers; use K25.4 or K26.4 for hemorrhage 1, 2
• Low-grade gastric MALT lymphoma - requires confirmation as treatment failure necessitates alternative therapy; use C88.4 1, 2
• Gastric cancer prevention in high-risk patients - family history or geographic risk; use Z80.0 (family history of malignant neoplasm of digestive organs) 3

Timing Requirements for Billing

• Testing must be performed at least 4 weeks after treatment completion to avoid false-negative results and ensure appropriate billing 1, 2, 4
• For bleeding peptic ulcers specifically, delay testing to 4-8 weeks after the bleeding episode 1, 2
• Testing before 4 weeks yields unreliable results and may not meet medical necessity criteria for reimbursement 1, 2

Billable Testing Methods

Document which test is being ordered to support the diagnosis code:

• Urea breath test (CPT 83013 or 83014) - sensitivity 94.7-97%, specificity 95-100% 1, 2
• Stool antigen test (CPT 87338 or 87339) - sensitivity and specificity >90% 1, 2
• Endoscopy with biopsy (CPT 43239) - when clinically indicated for high-risk scenarios 1, 2

Common Billing Pitfalls to Avoid

• Do not use B96.81 (Helicobacter pylori as the cause of diseases classified elsewhere) as the primary code for test of cure - this indicates active infection, not post-treatment follow-up 1
• Do not bill serology tests (antibody testing) for eradication confirmation - these have no role in determining treatment success and will likely be denied 1, 2
• Ensure proper medication washout is documented: PPIs discontinued for at least 2 weeks, antibiotics and bismuth for at least 4 weeks before testing 1, 2
• Document the original indication for H. pylori treatment in the medical record to support medical necessity 1, 2

Documentation Requirements

To support billing, your documentation should include:

• Date of H. pylori treatment completion
• Type of eradication regimen used
• Original indication for treatment (peptic ulcer, gastritis, dyspepsia, etc.)
• Confirmation that at least 4 weeks have elapsed since treatment
• Verification of medication washout (PPIs, antibiotics, bismuth)
• Clinical rationale for test of cure based on guidelines 1, 2, 4