Helicobacter pylori, Culture with Reflex to Susceptibility

Last Modified: 3/10/2021 2:31:21 PM

Medical Necessity Documentation:  
Client Notes:  
Patient Preparation:  
Specimen Requirements:

Pure isolate collected in Brucella or Trypticase Soy Broth (TSB) with 10-20% glycerol

Collection Instructions: Ship live cultures in a double-walled container or transport swab system submitted in 95kPa bag
Minimum Volume: 1 mm Biopsy
Transport & Storage: Temperature/Stability:

With Glycerol
Dependent on Viability - Ambient
Dependent on Viability - Refrigerated 
Unacceptable - Frozen  -20°
Dependent on Viability - Frozen -70°

All other specimens 
Dependent on Viability - Ambient
Dependent on Viability - Refrigerated
Unacceptable Frozen -20°
Dependent on Viability - Frozen -70°

Transport  -70° Frozen

Rejection Criteria: Clinical specimens • Grossly mixed isolates • Non-viable organisms •
Reference Range: Not Isolated
Critical Ranges:  
Test Comments: If Helicobacter pylori culture is Isolated, then Susceptibility, Helicobacter pylori, MIC will be performed at an additional charge (CPT code(s): 87181 x4).
Methodology: Culture
Clinical Significance: Helicobacter pylori has been associated with peptic ulcer disease and cancers of the gastrointestinal tract. In 1994, the U.S. National Institute of Health Consensus Development Conference concluded that H. pylori infection represents the major cause of peptic ulcer disease and antimicrobial treatment is recommended for patients with the confirmed disease.
Custom Panel: No


Turn Around Time: 4 to 5 days
Days Performed: Monday, Tuesday, Wednesday, Thursday, Friday
Sites Performed: Quest - Chantilly
PHL Test Code: MSOT
EPIC Test Code: MISC
Send Out Test Code: 36994
Alternate Test Names: H pylori, culture with reflex to susceptibility; H. pylori, culture with reflex to susceptibility; Susceptibility, Antimicrobial, Helicobacter pylori
Included Tests:  
CPT Coding: 87181 x 5

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