Pathology/Lab Coding Alert

Question: The pathologist received tissue from an EGD procedure identified by site: esophagus, stomach, and duodenum. How should we code the pathology exam?

Arkansas Subscriber

Answer: If the surgeon samples tissue from various distinctly identified anatomic sites during an esophagogastroduodenoscopy (EGD), the pathologist should separately report each tissue evaluation. In this case, that means reporting three units of 88305 (Level IV - Surgical pathology, gross and microscopic examination …)

Here are the three tissue specimens that the pathologist examines:

• 88305 — … duodenum, biopsy
• 88305 — … esophagus, biopsy
• 88305 — … stomach, biopsy

Beware payer rules: Some payers accept a single claim-line submission of 88305x3 for cases like this, but other payers expect you to list each procedure on a separate claim line. You may even find payers that require you to list the separate biopsy exams with a modifier, such as 59 (Distinct procedural service) or 76 (Repeat procedure or service by same physician or other qualified health care professional).