# How to code/bill BMA Injections



## kelly.armstrong (Feb 14, 2017)

Hello,  I do coding and billing for an Orthopedic surgeon.  He does BMA for many his surgeries. I bill 38220 for the BMA (bone marrow aspiration).  He wants me to bill for the injection as well, when he is injecting BMA in a site other than the surgery site (because I know it bundles with the surgery code when injecting into the surgical site)

For example, he may inject BMA into the knee when he does an ACL Repair via scope (29888), but then he injects BMA into the wrist or ankle or back because the patient is having pain there.  He wants to know why I can't bill a Trigger Point injection (20552 or 20553) if he's injecting in to the muscle of those locations other than the surgery site.

So my question is, can I use trigger point injection codes 20552 or 20553 to bill for BMA injections if it's in a different location than the surgical site?

Thanks so much for any help!

Kelly Armstrong, CPC


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## knedley (Feb 23, 2017)

*BMA coding*

I hope this will help clarify the use of BMA for different procedures performed.  Recommended CPT 0232T for the description you provided.  This code includes administration.  

Coding Brief: Bone Marrow Aspiration/Injection of Platelet/Stem Cells (0232T). CPT® Assistant. 
May 2012; Volume 22: Issue 5 

Category III code 0232T, Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed,was implemented effective July 1, 2010. Since implementation of code 0232T we have received questions related to the use of code 0232T when platelet rich stem cells are derived by bone marrow aspiration as opposed to venous blood collection.

Example: What code(s) should be reported for the purpose of deriving and injecting platelet rich stem cells from bone marrow aspirate for a patient with a diagnosis of nonunion of tibia fracture? Using a core needle and trocar, bone marrow aspiration into a 60-cc syringe was performed. Via a separate trocar insertion site, 35 cc of bloody aspirate was obtained, and the aspirate was prepared to obtain the platelet rich cells (ie, hematopoietic stem cells and mesenchymal stem cells). Next, the plate and screws were removed from the tibia. The platelet stem cells were then injected through a small stab incision into the tibial nonunion site. 

In this example, CPT Category III code 0232T should be reported for the injection into the operative site of the platelet rich plasma containing the stem cells[/U]. The harvest of bone marrow and bloody aspirate from the right iliac crest into a 60-cc syringe is considered inherent in code 0232T. Code 0232T is reported in addition to the definitive tibial fracture nonunion repair code (27724).  Since CPT coding guidelines may, however, differ from third-party payer guidelines, eligibility for payment, as well as coverage policy, is determined by each individual insurer or third-party payer. For reimbursement or third-party payer policy issues, please contact your local third-party payer.

Category III code 0232T involves collection of the specimen (either by venous blood collection or bone marrow aspiration), which is then spun down and the platelet rich plasma that is collected is injected into the operative site. Code 0232T also includes any imaging guidance used for harvesting and the preparation for injection. Therefore, it is not appropriate to report code 86999, Unlisted transfusion medicine procedure, for obtaining and centrifuging the blood drawn or to report code 86985, Splitting of blood or blood products, each unit, to describe the derivation of the platelets. In addition, none of the codes specific to aspiration or harvesting of bone marrow (eg, 38220, 38230, etc.) would be appropriate to report when the procedure is being performed to obtain platelet rich plasma. 
CPT Code 38220
Following add-on code 20938, Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure), a parenthetical note directs users: “For needle aspiration of bone marrow for the purpose of bone grafting, use 38220.” Code 38220, Bone marrow; aspiration only,involves aspiration of bone marrow for grafting in an arthrodesis procedure. When the bone marrow is obtained prior to the arthro-desis, the placement of the bone marrow aspirate is included as part of the arthrodesis procedure and not reported separately. Code 38220 also describes the diagnostic aspiration of bone marrow, as indicated in the following section.
Description of Procedure (38220)
The site chosen for the aspiration depends on the age of the patient. Most marrow aspirates from both children and adults are obtained through the iliac crest at the posterior superior iliac spine. In adults, the sternum and the anterior iliac crest may also be utilized. In children one year of age and younger, the anteromedial surface of the tibia is sometimes used, while in older children, the iliac crests or the vertebral spines may be aspirated.

After anesthetizing the skin and periosteum, the marrow needle is inserted through the skin and subcutaneous tissue to the bone with a slight twisting motion. The cortex of the bone is penetrated. The style of the needle is then removed and the hub of the needle is attached to a 10- to 20-ml syringe, and approximately 1 to 5 ml of fluid is aspirated. The needle is removed from the bone immediately after the marrow has been aspirated (ie, the aspiration does not produce intact tissue, but only the cellular contents of the needle). Pressure is applied at the site of the aspiration to prevent bleeding. 
CPT Code 38230
Codes 38230, Bone marrow harvesting for transplantation, allogeneic, and 38232, Bone marrow harvesting for trans-plantation, autologous, differ from codes 38220 and 0232T in that these proce--dures are used to report a bone marrow harvest from an autologous or allogeneic (related or un--related) donor. Both codes 38230 and 38232 are surgical procedures that include a preoperative day assessment, harvesting the bone marrow, the management of complications, and postoperative care by the physician.

The procedures described by codes 38220, Bone marrow; aspiration only, and 38221, Bone marrow; biopsy, needle or trocar, do not involve obtaining a sufficient amount of bone marrow for transplant purposes and are not separately reported if these services happened to be performed concurrently with code 38230.
Clinical Example (38230)
Patient is a 65-year-old female with aplastic anemia who has failed antithymocyte immunoglobulin therapy with cyclosporine. The patient has a sibling donor who is fully HLA matched.
Description of Procedure (38230)
The donor is brought to the operating room and general anesthesia is administered. Approximately 400 needle sticks are administered to collect bone marrow from the posterior iliac crest. Blood is given to the donor for red blood cell support, and as needed, irradiated packed RBCs are provided. The donor is moved to supine position, is extubated and transferred to the recovery room. 
Clinical Example (38232)
Patient is a 66-year-old male with multiple myeloma, who is unable to have a peripheral blood stem cell collection because of the use of pretransplant Revlimid. The patient’s marrow cellularity is approximately 20%.
Description of Procedure (38232)
The patient is brought to the operating room and general anesthesia is administered. Approximately 400 needle sticks are administered to collect bone marrow from the posterior iliac crest. Blood is given to the patient for red blood cell support as needed. The patient is moved to supine position, is extubated and transferred to the recovery room.  
CPT® Assistant copyright 1990-2013 American Medical Association. All rights reserved


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## dace18 (Jul 11, 2018)

*Bone Marrow Aspiration - Joint*

What is the correct coding for the following procedure:

Provider performs BMA using imaging guidance to aspirate cells. After cells are aspirated and harvested they are then injected into large joint using contrast & imaging guidance. Should I be using 0232T, 27370, and 73580? Would this be correct? IF not, what are the correct codes that should be billed?


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