Pathology/Lab Coding Alert

Question: Our pathologist evaluates a stomach resection from a sleeve gastrectomy performed for morbid obesity. I know the specimen exam is 88307, but I've been told that I should also always add 88342 with gastric specimens for an H. pylori stain -- is this correct?

Georgia Subscriber

Answer: You should report only what the pathologist's documentation supports. You are correct that a sleeve gastrectomy specimen exam warrants 88307 (Level V -- Surgical pathology, gross and microscopic examination, Stomach - subtotal/total resection, other than for tumor), in most cases.

Caution: A sleeve gastrectomy for treating morbid obesity generally involves removing a significant portion of the stomach, but if your pathologist receives an unusually small specimen, you might consider 88305 (Level IV - Surgical pathology, gross and microscopic examination, Stomach, biopsy).

The pathologist might also examine special stains to test for Helicobacter pylori. Although this is common for gastric specimens, you should not code for a special stain unless the pathology report documents it.

The pathologist might examine a Geimsa stain for H. pylori, which you would report as 88312 (Special stain including interpretation and report; Group I for microorganisms [e.g., acid fast, methenamine silver]). On the other hand, the pathologist might order an immunohistochemistry (IHC) stain, especially if inflammation is noted in the specimen. You would code an IHC stain as 88342 (Immunohistochemistry (including tissue immunoperoxidase), each antibody).

Do this: Report a special stain with a gastric specimen only when documentation identifies a specific special stain procedure.