Wiki Bone, excision

[tercanb]

Final Diagnosis: Bone, right foot excision (1.5 x 1.5 x 0.4cm): Acute osteomyelitis with osteonecrosis. Should it be a 88305 or 88307? Pathologist wants to charge 88305.

Thanks

Terri Blankenship, CPC

 

[danachock]

bone excession

Hi,
I don't have your entire pathology infront of me for review or the operative report, but I wanted to share a pathology I had similar to this scenario. I reviewed the operative and the physician had did a bone resection of the Great Toe due to acute osteomyelitis. Referring to the CPT book we applied the Bone Resection code 88309.
Thanks,
Dana Chock, CPC, CCA, CANPC, CHONC, CMPA
Anesthesia, Pathology, & Laboratory Coder

 

[bbooks]

We have been struggling with getting these coded correctly, too, especially when the requisition and path report indicate an amputation and are reporting osteomyelitis. We do not have ready access to the op note and it can be difficult trying to discern the indication for the bone removal.

How does one determine the difference between a resection and an amputation if neither term is used on the requisition or in the report? How does one categorize "excision" correctly as stated in the first example from Dana?

 

[bbooks]

May I ask about a couple of cases that are on my desk today? I would greatly appreciate any opinions.

Case #1
SPECIMEN:
A. Bone and debridement tissue, left foot

DIAGNOSIS:
Benign osteocartilaginous tissue, negative for osteomyelitis or neoplastic change.

CLINICAL HISTORY:
Cellulitis and abscess, open wound due to neuropathy and deformity

GROSS EXAMINATION:
"bone and debridement tissue left foot." The specimen consists of a 6 x 6 x 1.7 cm aggregate of multiple fragments of bone with a minimal amount of attached soft tissue. Sections, one following decalcification.

MICROSCOPIC EXAMINATION:
Sections demonstrate benign osteocartilaginous tissue. Inflammatory infiltrates are not identified.

Case #2
SPECIMEN:
A. Remaining 1st metatarsal, right foot

DIAGNOSIS:
Compatible with acute osteomyelitis, clinically right metatarsal bone.

CLINICAL HISTORY:
Chronic osteomyelitis, ankle and foot - foot abscess with infections

GROSS EXAMINATION:
"bone from remaining first metatarsal, right." The specimen consists of 2 fragments of bone aggregating 5 x 4 x 2 mm. All, one following brief decalcification.

MICROSCOPIC EXAMINATION:
Sections show fragments of osseous tissue with focal destruction of osseous trabeculae associated with scanty neutrophilic infiltration.

 

[bbooks]

I found a useful explanation in a previous thread here: https://www.aapc.com/MemberArea/forums/showthread.php?p=122774

In my previous message I coded Case #1 88307 because it said the specimen included "bone and debridement." Had it said only debridement, I would have coded 88304. There was no additional information with the requisition. Agree? Disagree?

Case #2 88304 because I had additional information on the requisition that said "repeat irrigated/debridement with closure right foot" with a pre-op diagnosis of "chronic osteomyelitis, ankle and foot." Agree? Disagree?