Pathology/Lab Coding Alert

Question: The pathologist received a specimen from surgery for a heel bone spur. The lab processed the specimen in one cassette following decalcification. What is the correct specimen for “bone spur?”

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Answer: A bone spur is equivalent to what CPT^® calls a “bone exostosis.” That means you should report the pathology exam as 88305 (Level IV - Surgical pathology, gross and microscopic examination … bone exostosis…).

The code selection for bone specimens can be difficult, because in addition to bone exostosis, CPT^® provides the following five other listed specimens identified as bone:

• 88304, Level III - Surgical pathology, gross and microscopic examination, Bone fragment(s), other than pathologic fracture
• 88305, … Bone marrow, biopsy…
• 88307, Level V - Surgical pathology, gross and microscopic examination, Bone – biopsy/curettings…
• 88307, … Bone fragment(s), pathologic fracture…
• 88309, Level VI - Surgical pathology, gross and microscopic examination, Bone resection…

An exostosis is defined as a benign bone and cartilage growth on a bone, so the bone spur is technically an exostosis, not a bone fragment.

Capture decalcification: You mentioned that the lab decalcified the specimen, which means that you should also bill +88311 (Decalcification procedure [List separately in addition to code for surgical pathology examination]) in addition to the 88305 charge.