CPT® Code 88007

1. Indications

The necropsy (autopsy) procedure described by CPT® Code 88007 is indicated for the following conditions:

• Determination of Cause of Death This procedure is performed to ascertain the underlying cause of death when it is not immediately apparent through external examination.
• Investigation of Disease Processes It is utilized to study the effects of diseases that may have contributed to the individual's death, providing insights into the progression and impact of various medical conditions.
• Legal and Forensic Purposes In cases where legal investigations are required, a necropsy can provide critical information that may be necessary for legal proceedings.

2. Procedure

The procedure for conducting a necropsy with gross examination of the brain and spinal cord involves several detailed steps:

• Step 1: Incision and Flap Creation An incision is made across the crown of the head from ear to ear, creating two flaps. The anterior flap is pulled over the face, while the posterior flap is extended down the back of the neck, providing access to the skull.
• Step 2: Opening the Skull A reciprocating saw is used to create a bone flap in the skull, which is then removed to expose the brain. This step is crucial for accessing the central nervous system.
• Step 3: Brain Removal The brain is carefully transected from the cranial nerves and spinal cord and lifted out of the cranial cavity. It is then placed in formalin for a period of 2-4 weeks to preserve and firm the tissue for further examination.
• Step 4: Spinal Cord Access 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 and peripheral nerves.
• 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. This step is essential for accessing the spinal cord.
• Step 6: Exposure of the Spinal Cord The paraspinal muscles are incised to expose the vertebral laminae. The vertebral arches are excised to reveal the spinal cord and its dural enclosure, which is then removed as a single unit along with the peripheral nerve roots.
• Step 7: Tissue Sampling Blocks of tissue may be removed and stored for later processing onto slides or cultured for microscopic examination and review, allowing for detailed analysis of the brain and spinal cord.
• Step 8: Closure of the Body After the autopsy is completed, the body cavity is lined with an appropriate material, and the internal organs are sealed in a plastic bag and returned to the body. The abdomen and chest flaps are re-approximated and closed, and the skull flap is replaced in the cranium before closing the scalp incision.

3. Post-Procedure

Post-procedure care following a necropsy involves ensuring that the body is properly prepared for any subsequent handling or burial. The body cavity is lined with suitable material, and the internal organs are returned to the body in a sealed plastic bag. The abdomen and chest flaps are carefully re-approximated and closed to maintain the integrity of the body. The skull flap is also replaced, and the scalp incision is closed to provide a natural appearance. It is important to document the findings of the necropsy thoroughly, as this information may be used for further medical research, legal purposes, or family inquiries regarding the cause of death.