One of our pathologists had argued that a bone spur is more appropriate as a 304 for a bone fragment and the same for an accessory navicular bone but another one of our pathologists answered this with the email below:

"Kind of a gray area and I don’t feel strongly about it, but I still favor exostosis for a bone spur (and probably an accessory navicular bone as well), because they are both attached to the surface of the bone. I guess once they have detached, then one could argue that they could be considered loose bodies, but I don’t think whether it was still attached/detached is necessarily specified all that often on the requisitions we get"

We are all pretty split down the middle on whether these should be a 304 or a 305 – does anyone have any thoughs?