Oncology & Hematology Coding Alert

Question: How is a bone marrow aspiration different from a bone marrow biopsy?

Ohio Subscriber

Answer: You report code 38220 (Bone marrow; aspiration only) for a bone marrow aspiration and 38221 (Bone marrow; biopsy, needle or trocar) for a bone marrow biopsy.

Your physician may perform a bone marrow aspiration and biopsy at the same site during the same session. In this case, you report 38221 for the biopsy and add G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) for the aspiration. You will need to confirm if your payer accepts this.

If your payer does not accept G0364, you can report 38220 in addition to 38221. if you’re reporting to Medicare (or a payer that shares Medicare’s rules), you should report both 38221 and G0364 to indicate performance of the two services through the same incision at the same session. Medicare’s Correct Coding Initiative Manual, Chapter V, Section E, explains:

• When the physician performs bone marrow aspiration alone, the appropriate code is 38220.
• When the physician performs bone marrow biopsy alone, the appropriate code is 38221.

Bone marrow aspiration is done to obtain fluid and cells from the marrow with a needle. Typically, biopsies are done using a large cutting needle. Your physician may perform a bone marrow biopsy to obtain samples for investigation. Remember, bone marrow biopsy is not the same as bone marrow transplant. Biopsies do not harvest enough of a marrow sample to facilitate a transplant.

Your physician may do multiple aspirations at the same site. In this case, you report code 38220 only once. The same applies to biopsies. However, when your physician does multiple biopsies at different sites, say the sternum and iliac crest or on bilateral sites of the iliac crest, you report the additional site by appending modifier 59 (Distinct procedural service) to 38221. It would be best to check with your payer, though.

Note: When your physician performs bone marrow aspiration and biopsy at separate sites or separate patient encounters, you may report 38220 and 38221. According to Medicare, ‘Separate sites include bone marrow aspiration and biopsy in different bones or two separate skin incisions over the same bone.’ Modifier 59 will help to override the edit when the procedures are appropriately documented and medical necessary.

Also: Your physician may do a bone marrow aspiration or biopsy under local anesthesia. In this case, you do not separately bill for the local anesthesia as it is bundled with the biopsy services.

Resource: You may download the “NCCI Policy Manual for Medicare Services” from www.cms.gov/NationalCorrectCodInitEd