Pathology/Lab Coding Alert

Question: When our pathologist examines bone fragments from joint replacement surgery, such as hip or knee, how should we code the specimen?


Minnesota Subscriber


Answer: Despite the fact that CPT Codes provides a code for joint resection (88305, Level IV--Surgical pathology, gross and microscopic examination, joint, resection), you should not use the code in all cases.
 
For a normal knee replacement, you should report  88305 for the joint resection. But if the patient has a complicating bone disorder, and the specimen involves a pathologic fracture, you should report 88307 (Level V--Surgical pathology, gross and microscopic examination, bone fragment[s], pathologic fracture).

For the specimen from hip replacement surgery, you would not usually use joint resection code 88305 because CPT provides a more specific option. Unlike a knee replacement, which involves bone from both sides of the joint, a hip replacement specimen typically involves only the femoral head, not the acetabelum.

Notice: CPT provides two codes for femoral head based on whether the specimen involves a fracture: 88304 (Level III--Surgical pathology, gross and microscopic examination, femoral head, other than fracture) or 88305 (Level IV--Surgical pathology, gross and microscopic examination, femoral head, fracture).