Oncology & Hematology Coding Alert

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

Ohio Subscriber

Answer: You report code 38220 (Diagnostic bone marrow; aspiration(s)) for a bone marrow aspiration and 38221 (Diagnostic bone marrow; biopsy(ies)) 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 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)).

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 a sample of a more solid part of the bone marrow 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 performs multiple aspirations or 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 XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) to the second 38220 or 38221. While this is typically the case, it is always best practice to check with your payer.

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.’ The correct modifier should be appended to 38220 to the coding pair and would override the bundling edit imposed by NCCI (National Correct Coding Initiative) when the procedures are appropriately documented and medically necessary. Don’t forget to consider the modifier 59 (Distinct procedural service) subsets, X{ESPU}, especially XS for this example.

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.