Pathology/Lab Coding Alert

Answer: There are eight bone specimens listed under surgical pathology codes 88304-88309 (Levels III-VI - Surgical pathology, gross and microscopic examination & ), and selecting the proper code can be difficult. The listed bone specimens are:

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

To answer your three specific questions, report a total knee resection submitted in fragments as 88305 (& joint, resection). If the surgeon identifies the specimen as a total knee resection, consider it a joint resection regardless of how it is received (whether fragmented or not).

You should not report the femoral head from a hip replacement surgery as a joint resection. The pathologist typically receives only the femoral head -- the acetabulum is normally ground down and is not submitted. Because femoral head is a specifically listed specimen, report 88304 (& femoral head, other than fracture) when you receive a femoral head without fracture from hip replacement surgery. If you receive both the femoral head and the acetabulum, however, report 88305 (& joint, resection).

An osteochondroma is a cartilaginous type of exostosis, therefore you should report this specimen as 88305 (& bone exostosis). Because osteochondromas are a benign neoplasm, the surgeon may perform a bone resection in rare cases. If so, report the service as 88309 (& bone resection). As in your first question, the specimen does not change whether it is submitted in fragments or intact.