Wiki 88304 vs 88307

[donna j rhodes]

For a sacral bone, decubitus ulcer debridement with a bone fragment that has a dx of acute osteomyelitis, would this be an 88304 or an 88307. I think an 88304 but an outside source is saying when it becames osteomyelitis that makes it an 88307.

any thought

donna

 

[shanahank]

cpc

I was taught that 88304 is for seriously sick patient, surgery not cancerous and 88307 was for neoplastic (cancerous). Hope this helps

 

[whaleheadking]

When you say "bone fragment" without qualification you've just painted yourself into a CPT-designated corner. If the bone fragment was submitted separately from the decubitus abscess specimen with a request from the surgeon to "r/o osteomyelitis" then you have a bone biopsy, 88307. If the bone fragment was submitted separately in conjunction with the debridement without a special request to do anything but identify the tissue and confirm its underlying pathology, this is 88304.

If the bone fragment was embedded in the debrided tissue submitted, I would consider this an incidental finding unless the surgeon called attention to it or if the pathologist determined it merited a unique and separate examination and diagnosis of its own, and that should be very clearly documented. Based on the clinical info you've provided I doubt anyone was astounded by the acute osteomyelitis diagnosis and it didn't alter the care plan.

The diagnosis does not drive code assignment in this kind of specimen. It is the surgeon's intent. If the surgeon wasn't asking for comment on the extent or nature of the underlying pathology, it is not a biopsy and it is not a Level V bone specimen.