Description

Intestinal dysbiosis may be defined as a state of disordered microbial ecology that is believed to cause disease, including conditions such as irritable bowel syndrome (IBS) and malabsorption. Laboratory analysis of fecal samples is proposed as a method of identifying individuals with intestinal dysbiosis. 

Background
The gastrointestinal tract is colonized by a large number and variety of microorganisms including bacteria, fungi, and archaea. The concept of intestinal dysbiosis rests on the assumption that abnormal patterns of intestinal flora, such as overgrowth of some commonly found microorganisms, have an impact on human health. Symptoms and conditions attributed to intestinal dysbiosis include chronic disorders such as IBS, inflammatory or autoimmune disorders, food allergy, atopic eczema, unexplained fatigue, arthritis, and ankylosing spondylitis, malnutrition, or neuropsychiatric symptoms including autism, and breast and colon cancer. 

Laboratory analysis of both stool and urine has been investigated as markers of dysbiosis. Reference laboratories specializing in the evaluation of dysbiosis may offer comprehensive testing of various aspects of digestion, absorption, microbiology, and metabolic markers. For example, Genova Diagnostics1 offers a Comprehensive Digestive Stool Analysis 2.0 that evaluates a stool sample for the following components: 

Digestion 

• Triglycerides 
• Chymotrypsin 
• Iso-butyrate, iso-valerate, and n-valerate 
• Meat and vegetable fibers 

Absorption 

• Long-chain fatty acids 
• Cholesterol 
• Total fecal fat 
• Total short-chain fatty acids 

Microbiology 

• Levels of Lactobacilli, bifidobacteria, and E. coli and other potential pathogens,<> including Aeromonas, Bacillus cereus, Campylobacter, Citrobacter, Klebsiella, Proteus, Pseudomonas, Salmonella, Shigella, Staphylococcus aureus, and Vibrio
• Identification and quantitation of fecal yeast (including Candida albicans, Candida tropicalis,
  Rhodotorula, and Geotrichum

Microbiology

• Levels of Lactobacilli, bifidobacteria, and E coli and other â‚¬Å“potential pathogens, including Aeromonas, Bacillus cereus, Campylobacter, Citrobacter, Klebsiella, Proteus, Pseudomonas, Salmonella, Shigella, Staphylococcus aureus, Vibrio. 
• Identification and quantitation of fecal yeast (including Candida albicans, Candida tropicalis,Rhodotorula, and Geotrichum

Metabolic Markers

• N-butyrate (considered key energy source for colonic epithelial cells) 
• Beta-glucuronidase 
• pH 
• Short-chain fatty acid distribution (adequate amount and proportions of the different short-chain fattyacids reflect the basic status of intestinal metabolism) 

Immunology

• Fecal secretory IgA (as a measure of luminal immunologic function) 
• Calprotectin 

The comprehensive stool analysis package has an optional parasitology component.    

Policy/Criteria

Fecal analysis of the following components is considered investigational as a diagnostic test for the evaluation of intestinal dysbiosis, irritable bowel syndrome, malabsorption, or small intestinal overgrowth of bacteria: 

• Triglycerides 
• Chymotrypsin 
• Iso-butyrate, iso-valerate, and n-valerate 
• Meat and vegetable fibers 
• Long-chain fatty acids 
• Cholesterol 
• Total short-chain fatty acids 
• Levels of Lactobacilli, bifidobacteria, and E coli and other potential pathogens, including Aeromonas, Bacillus cereus, Campylobacter, Citrobacter, Klebsiella, Proteus, Pseudomonas, Salmonella, Shigella, Saureus, Vibrio
• Identification and quantitation of fecal yeast (including C albicans, C tropicalis, Rhodotorula, and Geotrichum) 
• N-butyrate 
• Beta-glucuronidase 
• pH 
• Short-chain fatty acid distribution (adequate amount and proportions of the different short-chain fatty acids reflect the basic status of intestinal metabolism) 
• Fecal secretory IgA 

Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information.

Billing and Coding

Due to the nonspecific nature of the CPT codes used to identify different components of fecal analysis, identification of these claims may require identification of those laboratories that specialize in analysis for the evaluation of intestinal dysbiosis.

Professional Statements and Societal Positions Guidelines

N/A