CPT® Code 88005

1. Indications

The necropsy (autopsy) procedure described by CPT® Code 88005 is indicated for various reasons, primarily to ascertain the cause of death or to investigate disease processes. The following conditions may warrant the performance of this procedure:

• Unexplained Death: When the cause of death is not immediately apparent, a necropsy can provide critical insights.
• Suspicion of Disease: In cases where there is a suspicion of underlying disease processes that may not have been diagnosed during life.
• Legal Investigations: Autopsies may be required in legal cases to determine the cause of death in suspicious circumstances.
• Public Health Concerns: To investigate potential outbreaks of disease or to understand the impact of certain health conditions on populations.

2. Procedure

The procedure for conducting a necropsy with gross examination only, as outlined in CPT® Code 88005, involves several detailed steps:

• Step 1: Incision Creation An incision is made across the crown of the head from ear to ear, creating two flaps of skin. The anterior flap is pulled over the face, while the posterior flap is pulled down the back of the neck, providing access to the skull.
• Step 2: Skull Opening A reciprocating saw is utilized to open the skull, creating a bone flap that is carefully removed to expose the brain.
• Step 3: Brain Extraction The brain is transected from the cranial nerves and spinal cord and is lifted out for further examination. It is essential to place the brain in formalin for 2 to 4 weeks to preserve and firm the tissue before any additional analysis.
• Step 4: Spinal Cord Removal The spinal cord is removed using an anterior approach through the chest and abdomen. The paravertebral muscles are freed from the vertebrae, allowing visualization of the vertebral pedicles, peripheral nerves, and plexuses in the cervical and lumbar regions.
• Step 5: Vertebral Column Removal The pedicles are transected with an oscillating saw, and horizontal cuts are made through the intervertebral disc spaces to facilitate the removal of the vertebral column. The paraspinal muscles are incised to expose the vertebral laminae.
• Step 6: Dural Enclosure Removal The vertebral arches are excised to expose the spinal cord and its dural enclosure, which is then removed as a single unit along with the peripheral nerve roots.
• Step 7: Tissue Processing Blocks of tissue may be removed and stored for later processing onto slides or cultured for microscopic examination and review.
• Step 8: Closure After the autopsy is completed, the body cavity is lined with an appropriate material, the internal organs are sealed into a plastic bag and returned to the body, and the abdomen and chest flaps are re-approximated and closed. Finally, the skull flap is replaced in the cranium, and the scalp incision is closed.

3. Post-Procedure

Following the completion of the necropsy, several post-procedure considerations are important. The body cavity must be lined with appropriate material to ensure proper closure and to maintain the integrity of the body. The internal organs, after being examined, are sealed in a plastic bag and returned to the body. The abdomen and chest flaps are then re-approximated and closed securely. The skull flap is also replaced in the cranium, and the scalp incision is closed to restore the appearance of the deceased. It is essential to document all findings and any tissue samples taken for further analysis. The preservation of the brain in formalin for 2 to 4 weeks is crucial for subsequent microscopic examination, which may provide additional insights into the cause of death or underlying conditions.