HELICOBACTER PYLORI BREATH TEST (UREA BREATH TEST, UBT)
Test Code: LAB572
CPT Code: 83013 001 83014 001
Interface Code
UBTB
Synonym
H. PYLORI, H PYLORI, ULCER, PYLORI, UREA BREATH TEST, HELICOBACTER, BREATHTEK, UBiT, UBT
Specimen Type
Human breath: Paired breath samples (pre and post) collected in BreathID® Hp Collection Kit bags and must be submitted together. Follow instructions provided with kit.Submit specimen within 14 days.
Specimen Container
BreathID® Hp Breath Test Specimen Collection Kit
Specimen Handling
PATIENT PREPARATION:
1. UBT testing should not be performed on patients under the age of 3. Verify age. If under 3, do not administer this test. Notify Physician and immediate supervisor.
2. Inform the patient that the Citrica contains 84mg of phenylalanine per packet of Citrica Powder. Phenylketonurics restrict dietary phenylalanine.
3. The patient should have fasted at least one hour before administering the solution.
• No food for one hour prior to the test
• No liquid for one hour prior to the test
• No smoking for one hour prior to the test
4. The patient should not have taken any of the below for 2 week prior to testing:
• Bismuth/tritec
• All antibiotics
• Proton pump inhibitors (PPI) such as Prilosec OTC®, Prevacid®, Aciphex®, Protonix®, Nexium®
• Generic versions of PPI (medications containing omeprazole, lansoprazole, esomeprazole, pantoprazole and rabeprazole)
• Bismuth preparations such as Pepto-Bismol®
Collection Instructions: Use the BreathID® Hp Breath Test Specimen Collection Kit and follow instructions in the kit.
1. UBT testing should not be performed on patients under the age of 3. Verify age. If under 3, do not administer this test. Notify Physician and immediate supervisor.
2. Inform the patient that the Citrica contains 84mg of phenylalanine per packet of Citrica Powder. Phenylketonurics restrict dietary phenylalanine.
3. The patient should have fasted at least one hour before administering the solution.
• No food for one hour prior to the test
• No liquid for one hour prior to the test
• No smoking for one hour prior to the test
4. The patient should not have taken any of the below for 2 week prior to testing:
• Bismuth/tritec
• All antibiotics
• Proton pump inhibitors (PPI) such as Prilosec OTC®, Prevacid®, Aciphex®, Protonix®, Nexium®
• Generic versions of PPI (medications containing omeprazole, lansoprazole, esomeprazole, pantoprazole and rabeprazole)
• Bismuth preparations such as Pepto-Bismol®
Collection Instructions: Use the BreathID® Hp Breath Test Specimen Collection Kit and follow instructions in the kit.
Volume
Submit (2) filled bags per instructions
Temperature
Room Temperature
Unacceptable Conditions
Specimens submitted outside of stability. Specimens where the cap was not secure and specimen leaked out. Bags not submitted as a pair.
Methodology
Molecular Correlation Spectrometry (MCSTM)
Schedule
M-F
Additional Information
CPT Code is subject to a Medicare Limited Coverage Policy and may require a signed ABN when ordering. Additional CPT code 83014 will be applied if medication and collection is done at a PDL facility.
Stability
Room temperature: 14 days
Refrigerated: Unacceptable
Frozen: Unacceptable
Refrigerated: Unacceptable
Frozen: Unacceptable
Reference Range Information
Reference values are dependent upon methodology/instrumentation, check final report for current reference values
Turn Around Time
24 hour
Performing Site
Pacific Diagnostic Laboratories
| Result Code | Result Name | Result Loinc |
|---|---|---|
| 1510760 | Helicobacter pylori Breath Test (Urea Breath Test, UBT) | 29891-9 |
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