CPT® Code 88029

1. Indications

The necropsy procedure, identified by CPT® Code 88029, is indicated for the following conditions:

• Stillborn Infants - This procedure is performed on fetuses with a gestational age of 20 weeks or more that are born without signs of life.
• Newborns - Infants who are born alive but may have died shortly after birth, typically within the first month of life.
• Infants (1-12 months) - This includes infants who are between 1 and 12 months of age and have died under circumstances that warrant further investigation.

2. Procedure

The necropsy procedure involves several detailed steps to ensure a comprehensive examination of the stillborn or newborn infant:

• Step 1: External Examination - The procedure begins with a thorough external examination of the infant's body. This includes taking full body and facial photographs, if appropriate, to document any visible abnormalities. The body is weighed and measured in various dimensions, including crown to heel, crown to rump, head circumference, and foot length.
• Step 2: Radiographic Examination - Radiographic imaging may be performed to identify any new or healing bone fractures, skeletal dysplasia, metaphysitis, and cerebral calcifications. This imaging also helps estimate bone maturation at ossification centers.
• Step 3: Head Examination - The head is carefully examined for signs of trauma or abnormalities, such as abrasions, cephalohematoma, caput succedaneum, bulging fontanelles, and separated or overriding sutures.
• Step 4: Facial and Skin Examination - Facial features are noted, and the skin is examined for any irregularities. The shape of the chest is assessed, along with the presence of crepitus, while the abdomen's shape and size are also evaluated for conditions like omphalocele or gastroschisis.
• Step 5: Examination of Cord, Placenta, and Membranes - If attached, the umbilical cord, placenta, and membranes are examined for signs of umbilical hypercoiling or knots, chorioamnionitis, and infarction.
• Step 6: Genitalia and Anus Examination - The genitalia are examined to determine the infant's gender, and the patency of the anus, vagina, and urethra is assessed.
• Step 7: Back and Spine Examination - The back and spine are examined for neural tube defects, pigmented lesions, and hair tufts.
• Step 8: Gross Examination of Internal Organs - A gross examination of the internal organs is conducted using techniques similar to those described in CPT® Code 88000, ensuring a thorough assessment of all organ systems.
• Step 9: Microscopic Examination - Microscopic examination is performed on fluid and tissue specimens collected during the autopsy. These specimens are placed onto slides for review, cultured for pathogens, and tested for genetic diseases, metabolic disorders, or the presence of drugs or chemicals.
• Step 10: Closure of the Autopsy - Upon completion of the autopsy, the body cavity is lined with an appropriate material, the internal organs are sealed in a plastic bag and returned to the body, and the abdomen and chest flaps are re-approximated and closed.

3. Post-Procedure

After the necropsy is completed, the infant's body is treated with respect and care. The closure of the body is performed meticulously to ensure that it is prepared appropriately for any subsequent arrangements. The findings from the necropsy are documented in detail, providing valuable information for medical records and potential further investigations. The results may also assist in understanding the circumstances surrounding the infant's death, contributing to medical knowledge and potentially guiding future clinical practices.