Oncology & Hematology Coding Alert

Question: Our physician does a bone marrow aspiration and biopsy. Is it correct to report 38221? Can we also report code 38220?

Ohio Subscriber

Answer: You are trying to report a sequential bone marrow aspiration and biopsy. To decide the right code, you need clarity and documentation on the number of incisions and the specific sites involved.  

You have four different possible situations:

1. The physician performs a bone marrow aspiration alone. The best code is 38220 (Diagnostic bone marrow; aspiration(s)).
2. When the physician performs only a bone marrow biopsy, report code 38221 (Diagnostic bone marrow; biopsy(ies)).
3. When the physician performs a bone marrow aspiration and biopsy together (as described in the question). Your physician may do a bone marrow aspiration and biopsy together (as is indicated in your question). If performed at the same site through the same skin incision, you should report the new combination code 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)). However, if the documentation supports the aspiration and biopsy were done at separate sites or in separate patient encounters, you may report 38220 and 38221 together.

When do you report separate sites? You report aspiration and biopsy of bone marrow in separate sites when your physician attempts the two procedures in:

• Separate bones
• Separate skin incisions (separate surgical fields) over the same bone

Deleted code: As of January 1, 2018, you should no longer report G0364 (Bone marrow aspiration performed with bone marrow biopsy through the sameincision on the same date of service) to describe the bone marrow aspiration performed with bone marrow biopsy.

Note: Medicare indicates you shouldn't use modifier 59 (Distinct procedural service) to bill 38220 and 38221 together for a bone marrow biopsy and aspiration through the same incision.