Pathology Associates Of Lexington, P.A.

Gastrointestinal Biopsy (endoscopic) Charge Codes

Esophageal biopsies: These are done to evaluate tumors or polyps in order to rule in or rule out cancer. And they are done to evaluate ulcers and possible infections; and to evaluate medical disease such as esophagitis and GERD; and to evaluate whether Barrett's esophagus (BE)is present or not and to search for any premalignant change in Barrett's esophagus when BE is found.

CPT code	Reason	Notes about charge amount
spontaneous 2nd-5th opinions, intra-departmental consultations (IPCs)	routine pathologist instigated: other "heads" often better than one	no charge (we do several per week on GI cases)
requested in-house second opinion	your doctor may want the additional official opinion of a particular member of our group	no charge (we do several per month)
88305-26 one biopsy interpretation, M2-fixed, routine H&E stain	standard	full charge
88305-26 other separately labeled biopsies, each interpretation, M2-fixed, routine H&E stain	may need to know condition at different sites	may reduce the charge for subsequent sites
88312-26	needed sometimes to diagnose candidiasis	full charge but seldom needed (usually can see these fungi on H&E)
88142	rarely needed to diagnose HSV or CMV	full charge

Gastric (stomach) biopsies:

CPT code	Reason	Notes about charge amount
spontaneous 2nd-5th opinions, intra-departmental consultations (IPCs)	routine pathologist instigated: other "heads" often better than one	no charge (we do several per week)
requested in-house second opinion	your doctor may want the additional opinion of a particular member of our group	no charge (we do several per month)
88305-26 one biopsy interpretation,M2-fixed, routine H&E stain	standard	full charge
88142 IHC stain for H. p.	no stomach biopsy should go without this serious attempt to find this bacterium (H. p. is a class I carcinogen)	half charge
88305-26 other separately labeled biopsies, each interpretation,M2-fixed, routine H&E stain	may need to know condition at different sites	may reduce the charge
88312-26 d-PAS or GMS	look for candidiasis	full charge but seldom needed (usually can see fungi on H&E)
88312-26 DiffQuik stain	look for H. pylori bacteria	full charge

duodenal (and/or small intestine) biopsies:

CPT code	Reason	Notes about charge amount
spontaneous 2nd-5th opinions, intra-departmental consultations (IPCs)	routine pathologist instigated: other "heads" often better than one	no charge (we do several per week)
requested in-house second opinion	your doctor may want the additional opinion of a particular member of our group	no charge (we do several per month)
88305-26 one biopsy interpretation, M2-fixed, routine H&E stain	standard	full charge
88142 IHC stain for IELs	the most sensitive qualitative way to see IELs (with LCA or CD3) for chance for early celiac diagnosis	full charge
88360 IHC stain for IELs	for instrument assisted quantitation of the villus tip score (VTS) by IHC by "eyeball" visual calculation (some insurers balk at paying and here is why they must see this as valuable and pay)	full charge
88312-26 special stain, d-PAS	look for Whipple bodies	almost never needed

terminal ileum biopsies:

CPT code	Reason	Notes about charge amount
spontaneous 2nd-5th opinions, intra-departmental consultations (IPCs)	routine pathologist instigated: other "heads" often better than one	no charge (we do several per week)
requested in-house second opinion	your doctor may want the additional opinion of a particular member of our group	no charge (we do several per month)
88305	a routine & seldom abnormal	heavily discounted when with other separate biopsies
88312-26 special stain	for AFB & fungal organisms if granulomas are seen	rarely needed but full charge x2 in those rare cases

colonic biopsies:

CPT code	Reason	Notes about charge amount
spontaneous 2nd-5th opinions, intra-departmental consultations (IPCs)	routine pathologist instigated: other "heads" often better than one	no charge (we do several per week)
requested in-house second opinion	your doctor may want the additional opinion of a particular member of our group	no charge (we do several per month)
88305-26 one biopsy interpretation, M2-fixed, routine H&E stain	1st colonic biopsy	full charge
88305-26	serial subsequent biopsies
88313 or 88313-26	searching for collagen table thickening of collagenous colitis & other fibrosis (e. g. ischemic)	full charge
88142	searching for increased IELs of chronic microscopic lymphocytic colitic	full charge

rectal biopsies:

CPT code	Reason	Notes about charge amount
spontaneous 2nd-5th opinions, intra-departmental consultations (IPCs)	routine pathologist instigated: other "heads" often better than one	no charge (we do several per week)
requested in-house second opinion	your doctor may want the additional opinion of a particular member of our group	no charge (we do several per month)
88305-26 one biopsy interpretation, M2-fixed, routine H&E stain		full charge
88313 or 88313-26	searching for collagen table thickening of collagenous coloproctitis & other fibrosis (e. g. ischemic)	full charge
88142	searching for increased IELs of chronic microscopic lymphocytic colitic	full charge