Pathology/Lab Coding Alert

Don’t let the terminology confuse you.

Duodenum, polyp, resection for tumor, diverticulum, biopsy … that’s just a few of the words you might see in a pathology report for a small intestine specimen.

And those words could lead you to surgical pathology codes 88304, 88305, 88307, or 88309 (Level III, IV, V, or VI - Surgical pathology, gross and microscopic examination …). With payment ranging from $44.57 to $449.44 (Medicare national facility amount, conversion factor 34.023), choosing the wrong code could mean losing the pay you deserve.

That’s why we’ve devised this handy reference tool to help you decode the pathology report language you might see for small intestine specimens — and help you pick the right code, every time.

Find Help With This Glossary

The small intestine, by many other names, will code the same. You just need to learn those other names.

“The pathology report might use a variety of terms for small intestine specimens, depending on the surgical procedure and the pathologist’s findings,” says R.M. Stainton Jr., MD, president of Doctors’ Anatomic Pathology Services in Jonesboro, Ark.

We’ve scoped out a few of the common words you’ll need to know to select the proper surgical pathology code for small intestine, as follows:

• Small bowel: Synonym for small intestine; this is the part of the gastrointestinal tract following the stomach and preceding the large intestine (colon)
• Duodenum: The first section of the small intestine following the stomach and preceding the jejunum
• Jejunum: The middle section of the small intestine following the duodenum and preceding the ileum
• Ileum: The final section of the small intestine following the jejunum and preceding the colon
• Upper gastrointestinal (GI) tract: This refers to the esophagus, stomach, and duodenum
• Biopsy, small intestine: A sampling of tissue for examination and diagnosis, usually from a suspicious lesion, but typically not involving the entire lesion
• Resection other than for tumor, small intestine: Excised section of small intestine for reason other than tumor, typically involving the entire segment that exhibits pathology
• Resection for tumor, small intestine: Excised section of small intestine for neoplasm or growth suspicious for cancer, typically involving the entire segment that exhibits pathology
• Enterectomy: Small intestine resection; may be for tumor or other than for tumor
• Diverticulum, intestinal: Sac or pouch formed by herniation of internal wall of the intestine — often numerous (diverticula)
• Polyp, intestinal: Stalk-like growth arising from the mucous membrane of the intestine
• Gastric bypass tissue: Tissue from bariatric surgery typically involving a small section of intestine taken during anastomosis of the stomach and the jejunum.

Know the Listed Specimens

CPT^® lists small intestine specimens under numerous surgical pathology codes. Not every small intestine specimen is listed.

Below you’ll find the surgical pathology codes along with their associated listed small intestine specimens:

• 88304 — …diverticulum - esophagus/small intestine
• 88305 — … small intestine, biopsy duodenum, biopsy polyp, stomach/small intestine
• 88307 — … small intestine, resection, other than for tumor
• 88309 — … small intestine, resection for tumor.

“Notice that the distinction between an 88307 and 88309 small intestine resection is whether the pathologist evaluates the specimen for tumor — regardless of the final diagnosis,” says Peggy Slagle, CPC, coding and compliance manager for the department of pathology/microbiology at the University of Nebraska Medical Center in Omaha.

“For example, for a small intestine resection from a patient with a history of a malignant polyp, the evaluation is ‘for tumor,’ regardless of the final diagnosis,” Stainton says. The correct code would be 88309, not 88307.

Unlisted specimens: What about non-listed specimens? If the pathology report uses terminology other than what you see in the preceding list, you’ll need to select the appropriate code one of two ways:

1. If the term is a synonym for a listed specimen, choose that listed specimen. For instance, if the path report says ileum biopsy or small bowel biopsy, chose the code for small intestine biopsy (88305).
2. If the specimen is unlisted, you’ll need to select the appropriate code based on the level of work involved in the specimen compared to similar specimens. For instance, “gastric bypass tissue” might involve the level of work involved in a small intestine biopsy (88305) or a small intestine resection other than for tumor (88307), depending on the size of the specimen, the number of blocks/slides, or other measures of pathologist work.

Follow ‘Separate Specimen’ Rules

Picking the right code isn’t the only skill you’ll need for small intestine cases — because every case doesn’t represent only one code. The pathologist might examine multiple specimens from a single small intestine case, and you’ll need to know when you should (and shouldn’t) report them separately.

General rule: The unit of service for surgical pathology codes 88300-88309 is the specimen, which CPT® defines as “tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathologic diagnosis.” The service provided for each specimen is “accession, examination and reporting.”

For instance: If the surgeon submits a biopsy from the duodenum and a biopsy from the jejunum, you shouldn’t bundle the tissue and report it using a single code. Instead, you should report 88305 x 2.

Beware bundled tissues: When incidental tissue(s) come in the same container as a small intestine resection (often attached), you should typically bundle them as part of the resection. For instance, you shouldn’t separately bill a small piece of omentum or associated mesenteric/paracolic lymph nodes attached to the small intestine resection. Notice that such tissue doesn’t meet the “separate specimen” definition.