Pathology/Lab Coding Alert

Question: A pathologist in our office believes that we can’t classify a hip fracture due to osteoporosis as a “pathologic fracture,” because he doesn’t think the procedure warrants an 88307. Is that correct?

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Answer: The answer is yes, a hip fracture due to osteoporosis qualifies as a pathologic fracture, and no, the pathologic exam does not warrant 88307 (Level V - Surgical pathology, gross and microscopic examination, Bone fragment[s], pathologic fracture). 

Much orthopedic literature classifies osteoporosis as a cause — often the leading cause — of pathologic fracture. If the medical record and pathologist’s exam confirms that a hip fracture is a non-traumatic fracture due to underlying osteoporosis, both the ICD-9 code and the procedure code should reflect pathologic fracture.

That said, a femoral head (hip) fracture does not warrant reporting 88307 for a pathologic fracture. Instead, you should code a fractured femoral head as 88305 (Level IV - Surgical pathology, gross and microscopic examination, Femoral head, fracture). 

Here’s why: CPT® does not distinguish femoral head by pathologic versus non pathologic fracture, but simply by “fracture” or “other than fracture.” You should not use one of the codes for bone fragments to describe a femoral head specimen. You should always use the most specific code available, which in this case, is for a named bone — femoral head.