CPT® Code 88036

1. Indications

The procedure of necropsy (autopsy) is indicated under specific circumstances, particularly when there is a need to determine the medical cause of death or to gain insights into the pathological processes of diseases. The following conditions may warrant a limited necropsy:

• Medical Cause of Death The primary indication for performing a necropsy is to ascertain the medical cause of death, especially in cases where the cause is unclear or disputed.
• Pathological Insight Necropsies provide valuable information regarding the progression of diseases and the effectiveness of treatments administered prior to death.
• Family Preferences In some instances, families may request a limited necropsy due to religious or personal beliefs, which may influence the extent of the examination performed.

2. Procedure

The necropsy procedure involves several detailed steps to ensure a thorough examination of the deceased. Each step is critical for obtaining accurate findings:

• External Examination The procedure begins with a comprehensive external examination of the body. This includes documenting any visible wounds, taking photographs, and possibly utilizing radiologic films. The body is then cleaned, weighed, and measured, followed by a detailed description that includes gender, approximate age, ethnicity, hair color and length, eye color, and distinguishing features such as tattoos, scars, moles, or birthmarks.
• Chest Examination To access the internal chest organs, a “Y” incision is made from the top of each shoulder diagonally down to the sternum, continuing as a single centerline incision down to the pubic bone. Alternatively, a “T” incision or a midline vertical incision may be used. The ribs are transected along both sides, allowing the ribs and sternum to be lifted as a single unit to expose the chest cavity.
• Heart and Circulatory System Examination The pericardial sac is opened to view the heart, and blood samples may be taken from the inferior vena cava or pulmonary veins. The pulmonary artery is examined for blood clots, and major vessels are transected to facilitate the removal of the heart.
• Pulmonary System Examination The left lung is removed by transecting the bronchus, artery, and vein at the hilum, followed by the right lung. This step allows for a thorough examination of the pulmonary system.
• Abdominal Organ Examination A midline incision is made from the xiphoid process of the sternum to the pubic bone to access the abdominal organs. Each organ is examined in relation to surrounding blood vessels before being removed individually or as a block by dissecting along the vertebral column.
• Brain Examination For a brain examination, 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, and the posterior flap is pulled down the back of the neck to expose the skull. A bone flap is created and removed to access the brain, which is then transected from the cranial nerves and spinal cord and lifted out. The brain must be placed in formalin for 2-4 weeks for preservation before further examination.
• Microscopic Review If a microscopic review is ordered, fluid and tissue specimens removed during the necropsy are processed onto slides for analysis, cultured for pathogens, and tested for drugs, chemicals, genetic diseases, or metabolic disorders.
• Closure At the conclusion of the necropsy, the body cavity is lined with appropriate material, the internal organs are sealed in a plastic bag and returned to the body, the skull flap is replaced, and all incisions are re-approximated and closed.

3. Post-Procedure

After the necropsy is completed, the body is prepared for final disposition according to the family's wishes and any applicable legal requirements. The internal organs, once examined, are typically returned to the body cavity, and the incisions are meticulously closed to maintain the integrity of the body. It is important to ensure that the body is treated with respect and dignity throughout the process. The findings from the necropsy may be documented in a report, which can provide valuable information for the family, healthcare providers, and any legal authorities involved. Additionally, if microscopic examinations were performed, the results may take additional time to process and report, contributing further to the understanding of the cause of death and any underlying conditions.