Helicobacter Pylori, Urea Breath Test, (Adult)

Test Name Helicobacter Pylori, Urea Breath Test, (Adult)
Test Code 499
CPT Code(s) 83013
Preferred Requirement(s) Breath Test Collection Kit
Transport Temperature A = 1 week
Methodology Infrared spectrophotometry, co2 isotope
Days Performed Tues-Fri
Special Instructions Patient preparation:
1. Remind the patient that pranactin-citric contains
phenylalanine (one of the components of aspartame).
2. Phenylketonurics restrict dietary phenylalanine.
3. The patient should fast at least 1 hour before
beginning the test.
4. The patient should not have taken antimicrobials,
(antibiotics), proton pump inhibitors or bismuth
preparations within the previous 2 weeks prior to
testing.
Note: common bismuth and proton pump inhibitors
include the following:
bismuth: pepto-bismol, kaopectate and pink bismuth.
proton pump inhibitors: nexium, prevacid, zegerid
and prilosec.
5. The patient should stop taking h2ras for 24-48 hours
prior to testing because they may reduce urease
activity on urea breath tests.
Note: common h2ras include the following:
pepcid, zantac, axid and tagamet.
6. The patient may continue taking antacids prior to
testing.
Procedure:
1. Label bags with 2 patient identifiers, such as name
and date of birth or bar code label. Label specimens
with collection time.
2. Collect the baseline breath sample as follows:
remove cap from blue collection bag.
instruct the patient to breathe normally.
have the patient take a deep breath, then pause
momentarily.
have the patient exhale into mouthpiece of the bag.
replace cap firmly until it clicks on the mouthpiece
of the bag.
3. Prepare the pranactin-citric solution.
empty packet completely from test kit into the cup
provided.
add drinking water to the fill line (raised edge).
it is important to close the lid securely by pressing
down until you hear a click.
4. Swirl mixture for up to two minutes until completely
dissolved. The solution should be clear with no
particulate matter. If solution is not clear, it
should not be used. The solution is stable for
60 minutes at room temperature.
5. Instruct the patient to drink the solution without
stopping, using the straw provided. Not using the
straw provided in the kit may result in inaccurate
test results. Advise the patient not to rinse the
mouth with the solution before swallowing.
6. Set the timer for 15 minutes. Start timer as soon as
patient has completed drinking. Patient should sit
quietly without eating, drinking or smoking.
7. Collect the post-dose breath sample after the timed
15 minutes have elapsed. The sample may be collected
no later than 30 minutes after administering the dose.
remove the cap from the pink collection bag.
instruct the patient to breathe normally.
have the patient take a deep breath, then pause
momentarily. Have the patient exhale into mouthpiece of the bag.
replace cap firmly until it clicks on the mouthpiece
of the bag.
Indicate the collection time of each sample on the
requisition.
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