Laboratory Studies for Diagnosing and Managing Inflammatory Bowel Disease

Section: Laboratory
Effective Date: September 01, 2019
Revised Date: August 22, 2019
Last Reviewed: August 12, 2019

Description

Inflammatory Bowel Disease (IBD) refers to a chronic and relapsing inflammatory disorder of the gastrointestinal tract GIT accompanied by abdominal pain, rectal bleeding and malabsorption. It comprises two major entities, ulcerative colitis UC and Crohn's disease CD.

Serologic panels of multiple antibodies are proposed to aid in differential diagnosis of CD versus UC in stratifying patients according to disease phenotype and risk of complications.

Criteria

Fecal calprotectin testing may be considered medically necessary for ANY of the following:

  • Evaluation of individuals when the differential diagnosis is IBD; or
  • Evaluation of individuals demonstrating symptoms of active disease; or
  • Evaluation for mucosal healing when colonoscopy is being considered; or
  • Evaluation for response to biologic or therapy escalation when colonoscopy is being considered; or
  • IBD for which endoscopy with biopsy is being considered.

Fecal calprotectin testing is considered experimental/investigational for all other indications because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Procedure Codes

83993

Molecular pathology testing using serological markers/laboratory tests for the diagnosis or management of IBD are considered experimental/investigational. There is a lack of scientific evidence that the use of these tests is likely to alter the diagnostic workup, the final diagnosis made, or the treatment provided for patients with suspected IBD.

Procedure Codes

81401 89240

Examples of serological markers/laboratory tests include:

  • Anti-neutrophilic cytoplasmic antibody (ANCA), perinuclear anti-neutrophilic cytoplasmic antibody (pANCA)
  • Anti-saccharomyces cerevisiae antibody (ASCA)
  • Anti-outer membrane porin C (anti-OmpC) antibody
  • Anti-CBir1 flaggellin (anti-CBir1) antibody
  • Anti-I2
  • Anti-laminaribioside carbohydrate IgG (ALCA)
  • Anti-laminarin (anti-L)
  • Anti-chitobioside carbohydrate IgA (ACCA)
  • Anti-mannobioside antibodies IgG (AΣMA ) or AMCA)
  • Pseudomonas associated sequence I-2 (Anti-I2)
  • Antibodies against exocrine pancreas (PAB)
  • Antibodies to goblet cells (GAB)

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