General Surgery Coding Alert

Question: When I read an op note for a bone marrow procedure, I’m confused about the difference between aspiration and biopsy. How do I distinguish the procedures so I can assign the correct code?

Michigan Subscriber

Answer: First of all, the surgeon should indicate specifically whether the procedure is a bone marrow biopsy or a bone marrow aspiration. If the op note lacks that specific designation, you can use the procedure description to tell the difference.

Key: Bone marrow is a spongy, semi-solid tissue containing fluid and cellular material. “A bone marrow aspiration uses a fine gauge needle and withdraws a specimen of fluid and cells,” says R.M. Stainton Jr., MD, president of Doctors’ Anatomic Pathology Services in Jonesboro, Arkansas. A bone marrow biopsy uses a larger-bore hollow needle to withdraw a core of bone marrow tissue.

To report the aspiration, you should use 38220 (Diagnostic bone marrow; aspiration(s)). For the biopsy, report 38221 (Diagnostic bone marrow; biopsy(ies)).

Both: If the surgeon performs both procedures together at the same anatomic site, you should report 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)). Performing both procedures is common, because the specimens provide distinct diagnostic information for blood cell diseases such as leukopenia, thrombocytopenia, or blood cancers like leukemias or lymphomas.

Separate: If the surgeon performs multiple aspirations or biopsies at separate sites, such as the left and right sides of the pelvis, you can report each procedure and append a modifier to the second code. Depending on payer preference, you might use modifier 59 (Distinct procedural service) or modifier XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure).