Pathology/Lab Coding Alert

Question: Our pathologist works with a gastroenterologist at our hospital for fecal microbiota transplants (FMT). The pathologist assess the donor specimen, including testing for specific infectious agents to prepare the specimen for fecal microbiome transplant (FMT). How can we code the pathologist’s work?

Tennessee Subscriber

Answer: For non-Medicare patients, you may bill the pathologist’s work that you describe using 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen).

The physician who then instills the microbiota transplant will bill a separate code for the installation depending on the route of transplant, such as 43235 (Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)). A surgeon or gastroenterologist will typically perform this portion of the work.

Medicare: If you’re dealing with a Medicare patient, your pathologist may be out of luck. Medicare won’t cover the 44705 code, but instead expects providers to bill G0455 (Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen). You can see that this code covers both the fecal microbiota preparation and instillation. If your pathologist doesn’t perform both parts of the procedure, you can’t bill the code.