Wiki How to code for gross and microscopic exam???

[jticbs]

Hi, I need an expert opinion on this example below:

The Pathologist, Dr. Quincy, performs a gross and microscopic examination on the surgical specimen of a patient who has undergone a left total hip replacement. Code for Dr. Quincy.

I was undecided between 88304 and 88305. I can't figure out hip replacement due to femur fracture (88305) not other then fracture (88304)???

If you come up with another code, please let me know. Thanks.

JT.

 

[kkonkle]

What is documented in the pathology report? That will guide your coding.

 

[JEYCPC]

The way I understand it is that a joint resection is a 88305. A bone fragment (other than pathologic fracture) would be 88304. So, kkonle is correct. What's documented?