Pathology/Lab Coding Alert

Question: The pathologist examines a stomach biopsy taken during an esophagogastroduodenoscopy and orders a lab test for Helicobacter pylori. How should we code the service?

Missouri Subscriber Answer: You should code the pathologist's work for examining the biopsy specimen as 88305 (Level IV -- Surgical pathology, gross and microscopic examination, stomach, biopsy). 

For the Helicobacter pylori test, choose the appropriate code based on the lab method. A common test for a stomach biopsy specimen is 86677 (Antibody; Helicobacter pylori). 

CPT provides many other codes for Helicobacter pylori testing from different specimen types, including the following:

- 78267 -- Urea breath test, C-14 (isotopic);  acquisition for analysis

- 78268 -- - analysis

- 83009 -- Helicobacter pylori, blood test analysis forurease activity, non-radioactive isotope (e.g., C-13)

- 83013 -- Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (e.g., C-13)

- 86318 -- Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step method (e.g., reagent strip)

- 87338 -- Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method;  Helicobacter pylori, stool

- 87339 -- - Helicobacter pylori. Tip: Many waived-status tests under Clinical Laboratory Improvement Amendments (CLIA) use this method, and you should report these tests with modifier QW (CLIA waived test).