Pathology/Lab Coding Alert

Question: How should I report a bone marrow biopsy consisting of a bone fragment measuring 0.6 cm in length x 0.2 cm in diameter and a fragment of a clot measuring 0.4 cm in diameter? Several smears are also received.

Minnesota Subscriber

Answer: A bone marrow study commonly involves the tissue types that the question describes. Because this scenario includes several procedures and specimens, report each separately to ensure appropriate payment.

Typically, the bone marrow biopsy consists of a core of bone with marrow sandwiched in between the bone spicules. If this is the specimen you describe as a "bone fragment," the proper code is 88305 (Level IV - Surgical pathology, gross and microscopic examination, bone marrow, biopsy). Your pathology report probably also mentions that this specimen was decalcified, which is a separately reportable service (+88311, Decalcification procedure [list separately in addition to code for surgical pathology examination]).

The clot is separately processed and examined, so report that service as 88305 ( cell block, any source). Likewise, bill separately for the smears using 85097 (Bone marrow, smear interpretation).

Although you don't mention them, bone marrow studies commonly involve special stains. If the pathology report mentions these, bill for each different stain using the appropriate code (e.g., +88312, Special stains [list separately] in addition to code for surgical pathology examination); Group I for microorganisms [e.g., Gridley, acid fast, methenamine silver], each; +88313, Group II, all other, [e.g., iron, trichrome], except immunocyto-chemistry and immunoperoxidase stains, each; or 88342, Immunocytochemistry [including tissue immunoper-oxidase], each antibody).