# Bone Marrow Aspiration/Marrow Coding  HELP!



## kelliephillips (Dec 5, 2017)

Can anyone give me some insight on reporting 38220, 38221 for Hospital Outpatient coding and reporting guidelines? This is a big discussion within our department.

some feel that 38221 is the only code that should be reported for aspiration/biopsy. 

Others feel that if they do aspiration and biopsy that both should be reported, 38220 and 38221. 

How can we distinguish the two and know what codes are accurate to report?


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## m.j.kummer (Dec 5, 2017)

*The issue is resolved for 2018*

For 2018:
38222 - Diagnostic bone marrow; biopsy(ies) and aspiration(s) will take care of this issue. Until then, 38220 is unbundled when reported with 38221 unless it is in an anatomically different site, etc. 


2018: For CY 2018, the CPT Editorial Panel made the following changes to the family of codes for bone marrow aspiration: CPT codes 38220 and 38221 were redefined to reflect only bone marrow aspiration (38220) and bone marrow biopsy (38221) for diagnostic purposes. CPT 38222 was created to describe a diagnostic bone marrow procedure that bundles biopsy and aspiration into one code. Since CPT 38222 now accurately describe the services currently reported by G0364, CMS eliminated HCPCS code G0364 for CY 2018. A new add-on code 20939 was approved for coding bone marrow aspiration for spine surgery. This code will only be utilized for spine surgery procedures conducted by orthopedic surgeons and neurosurgeons doing spine autograft procedures. CPT 20939 describes harvesting bone marrow which involves performing a corticotomy, often with a trephine, in order to gain access to and withdraw the bone marrow, comprised of both hematogenous and trabecular bone tissue. The procedure requires targeting, confirmation of position, and retrieval/acquisition of bone marrow to mix with allograft. The base codes for 20939 include the following spinal fusion codes: 22319, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22590, 22595, 22600, 22610, 22612, 22630, 22633, 22634, 22800, 22802, 22804, 22808, 22810, and 22812. Source: CPT Editorial Summary of Panel Actions September-October 2016
2018: New code effective 01-01-2018


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## marcy25 (May 2, 2018)

*Marcy*



kelliephillips said:


> Can anyone give me some insight on reporting 38220, 38221 for Hospital Outpatient coding and reporting guidelines? This is a big discussion within our department.
> 
> some feel that 38221 is the only code that should be reported for aspiration/biopsy.
> 
> ...





This may be helpful
https://www.aapc.com/blog/41243-aspiration/

In 2017 only report the 38221 if the aspirate was performed on the same sight as biopsy with the exception of Medicare as payer.  If Medicare is the payer report the 38221 AND the G0364.

If the aspirate was performed with the biopsy on a "separate" incision site report both the 38221 and 38220 (59) modifier applied to 38220 regardless of the payer.


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## jendp79 (Apr 18, 2019)

*Bone Marrow Aspiration code 20939*

Trying to clarify this, it states, A new add-on code 20939 was approved for coding bone marrow aspiration for spine surgery. This code will only be utilized for spine surgery procedures conducted by orthopedic surgeons and neurosurgeons doing spine autograft procedures. The description states "through separate incision". 

My question is if the neurosurgeon is performing surgery in the cervical area and the skin is already open, do you still use 20939? Any help would be greatly appreciated!!


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## christina75 (Apr 19, 2019)

*20939 When to use*



jendp79 said:


> Trying to clarify this, it states, A new add-on code 20939 was approved for coding bone marrow aspiration for spine surgery. This code will only be utilized for spine surgery procedures conducted by orthopedic surgeons and neurosurgeons doing spine autograft procedures. The description states "through separate incision".
> 
> My question is if the neurosurgeon is performing surgery in the cervical area and the skin is already open, do you still use 20939? Any help would be greatly appreciated!!




That is a great question as I have the similar one dealing with the L4-5 bone marrow aspirated was taken the a re tractor was docked on the L4-5. No separate incision was made so i believe 20939 can NOT be used in this case as CPT guidelines indicate a separate incision needs to be made to use this code.
I am interested in other individuals feed back on this.
Thanks
Christina


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