Pathology/Lab Coding Alert

88304-88309 hold the keys.

Selecting a surgical pathology code might seem straightforward, but sometimes a specimen blurs the code definitions, leaving you with a tough decision. 

That can be especially likely in the case of bone specimens, because CPT® provides eight separate codes for bone tissue pathology exam in the range 88304-88309 (Levels III-VI — Surgical pathology, gross and microscopic examination, …) as follows: 

• 88304 — Bone fragment(s), other than pathologic fracture
• 88304 — Femoral head, other than fracture
• 88305 — Bone exostosis
• 88305 — Femoral head, fracture
• 88305 — Joint, resection
• 88307 — Bone - biopsy/curettings
• 88307 — Bone fragment(s), pathologic fracture
• 88309 — Bone resection.

Try your hand at assigning the correct bone-specimen exam code using the following scenario; then check your answer against our expert’s advice.

Study the Case

Pre-op diagnosis: Humeroulnar fracture, osteoporosis

Specimen: Pathologist receives three pieces of bone in one container labeled “humeroulnar joint fragments.” Pathologist examines the fragments grossly and measures the fragments as 2 x 1.5 cm, 1 x 1.5 cm, and 0.8 x 1 cm. 

Procedure: The lab decalcifies the tissue and processes it in three paraffin embedded-blocks. The pathologist examines hematoxylin and eosin (H&E) stained slides from each block, noting decreased bone mass and diminished lamellar structure.

Diagnosis: The pathologist confirms the diagnosis of osteoporosis-related fracture. 

See if you can assign the proper procedure code(s) for this case using codes from the preceding list of bone codes, as well as any other pertinent procedures. 

Check Your Answer

You have three clues that could lead you to different conclusions about the appropriate surgical pathology code choice for this procedure:

• The specimen is from a joint (humeroulnar joint, or elbow). Should you use 88305 (… Joint, resection)?
• The bone shows pathology (osteoporosis). Should you report 88307 (… Bone fragment[s], pathologic fracture)?
• There are three bone fragments. Should you report three units of either 88304 (Bone fragment[s], other than pathologic fracture) or 88307?

Do this: The correct code for the procedure is one unit of 88307. “This specimen isn’t a joint resection because the pathologist does not receive the entire joint or a significant portion of the joint as you would expect from a joint replacement surgery,” says R.M. Stainton Jr., MD, president of Doctors’ Anatomic Pathology Services in Jonesboro, Ark.

Caution: Whether the pathologist receives a joint in fragments or not would not normally affect your code selection. The key in this case is that the fragments are a small portion of the joint, and that the overriding condition in this case is the examination of bone fragments for a fracture due to a pathological bone condition. 

Despite receiving three bone fragments that the lab processes and the pathologist examining them as three separate blocks, you should report just one unit of 88307. “The pathologist receives the three fragments in one container with no distinguishing identifiers indicating that the surgeon wants separate diagnoses, so the pathologist will look at this as one specimen,” Stainton says. Also notice that the code definition states, “fragment(s),” indicating that a single unit of the code is appropriate for one or more bone fragments.

Don’t miss: You should separately report the decalcification procedure using 88311 (Decalcification procedure [List separately in addition to code for surgical pathology examination]). You shouldn’t report a special stain code, because the H&E stain is a standard stain and not separately billable.