Oncology & Hematology Coding Alert

Question: When a provider performs a bone marrow aspiration, which CPT^® code is the most appropriate to use: 38220, 38221, or 38222?

New York Subscriber

Answer: Code choice in this situation very much depends on anatomic site and whether the provider performed aspiration only, biopsy only or both at the same session/encounter.

You would report 38220 (Diagnostic bone marrow; aspiration(s)) when your provider performs diagnostic bone marrow aspiration to obtain diagnostic material for pathologic testing; 38221 (Diagnostic bone marrow; biopsy(ies)) when your provider performs a diagnostic bone marrow biopsy; and 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)) when your provider performs both a diagnostic aspiration and biopsy at the same encounter and anatomic site per CPT^® Assistant (May 2018, Volume 28: Issue 5).

If your provider performs multiple diagnostic aspirations, biopsies, or aspirations with biopsies at the same anatomic site, you may not report them separately. However, if your provider performs multiple diagnostic aspirations, biopsies, or aspirations with biopsies at different anatomic sites, you may append modifier 59 (Distinct Procedural Service) to the second line item of the applicable code.

Keep in mind: The Centers for Medicare and Medicaid Services (CMS) introduced the X modifiers — XU (Unusual non-overlapping service …), XS (Separate structure …), XP (Separate practitioner …), and XE (Separate encounter …) — as a subset of modifier 59, and your payer may want to see one of these instead.

Remember this (1): You should not report both 38220 and 38221 for the same patient encounter when obtaining diagnostic bone material for pathological testing. However, the National Correct Coding Initiative (NCCI) Policy Manual explains that these two codes may be reported together “…if the two procedures are performed without accompanying biopsy(ies) or aspiration(s) respectively on different iliac bones or sternum or at separate patient encounters.” In such cases you will need to append a modifier to override the NCCI bundling edit.

Remember this (2): Very often, providers perform bone marrow aspirations under local anesthesia. When this happens, do not separately bill for the local anesthesia, as it is bundled within the aspiration service code.