Pathology/Lab Coding Alert

Question: A 78 year-old female patient diagnosed with osteoporosis fractured her hip and underwent hip replacement surgery. The pathologist received bone fragments from the surgery and identified the fragments as the femoral head. Should we report this specimen as 88304 (Bone fragment[s], other than pathologic fracture), 88305 (Femoral head, fracture), 88305 (Joint, resection) or 88307 (Bone fragment[s], pathologic fracture)? Iowa Subscriber

Answer: You should report 88305 (Level IV-- Surgical pathology, gross and microscopic examination,femoral head, fracture). CPTdistinguishes the femoral head based on whether it is fractured (88305) or not (88304, Level III -- Surgical pathology, gross and microscopic examination, femoral head, other than fracture).

Because you know that the bone is the femoral head, you should not report one of the less specific codes for bone fragments - 88304 (... bone fragment[s], other than pathologic fracture) or 88307 (Level V-- Surgical pathology, gross and microscopic examination, bone fragment[s], pathologic fracture).

Although hip replacement surgery may entail a joint resection, the specimen in your case does not include the entire joint. Because the pathologist does not identify the acetabulum, you should not report this specimen as a joint resection (88305, ... joint, resection).

The fact that the patient has osteoporosis might justify categorizing the specimen as a pathologic fracture, but CPT does not make that distinction for the femoral head as it does for the bone fragments specimen.

-- Reader Questions were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors'Anatomic Pathology Services in Jonesboro, Ark.