Pathology/Lab Coding Alert

Question: According to the surgical report for a knee resection, a patient diagnosed with Padget's disease presented with a fractured knee that was misshapen from bone overgrowth. The surgeon submitted the specimen in fragments, which our pathologist examined and confirmed the diagnosis based on characteristic Padget's mosaic pattern on H&E slides. Should we code the exam as 88305 for joint resection or 88307 for pathologic fracture?

Texas Subscriber

Answer: The pathologist should make the call in this case, but it appears that 88307 (Level V - Surgical pathology, gross and microscopic examination, Bone fragment[s], pathologic fracture) is the better choice for the situation you describe.

Other choice: The specimen involves a joint resection, and CPT® provides a code for that (88305, Level IV - Surgical pathology, gross and microscopic examination, joint, resection). Whether the pathologist receives the joint in fragments or not would not normally affect your code selection.

The overriding condition for this case, however, is the examination of bone fragments with pathologic fracture. Based on the patient's pre-op diagnosis of a fractured knee related to Padget's disease, and the pathologist's findings that confirm the condition, the most specific code for this case would be 88307.