Pathology/Lab Coding Alert

Here's how to avoid this coding red flag Yes, you have to use a CPT surgery code when your pathologist extracts a needle bone-marrow biopsy specimen, but be careful which code you choose.

If you use 20220 or 20225 to report the service when your pathologist obtains marrow for hematological review or bone-marrow biopsy interpretation, your claim could go straight into the denied stack. 20220 Signals Bone, Not Bone-Marrow Specimen When your pathologist extracts a bone-marrow specimen, don't let the terms "needle," "trocar" or "bone" confuse your code selection. A bone biopsy and a bone-marrow biopsy represent two different specimens, and you have to report the surgical code accordingly.

You would only use 20220 (Biopsy, bone, trocar, or needle; superficial [e.g., ilium, sternum, spinous process, ribs]) or 20225 (... deep [e.g., vertebral body, femur]) for a bone biopsy, not a bone-marrow biopsy. A surgeon, not a pathologist, typically performs bone biopsies.

The pathologist does not use a bone biopsy procedure "to get a bone-marrow sample for hematological evaluation," says Timothy Carter, MD, medical director for Rex Healthcare in Raleigh, N.C. Rather, a surgeon may perform the bone biopsy "to get a piece of bone for other purposes," he says.

Scenario: To determine the infecting organism in a patient with osteomyelitis, a surgeon uses a needle to remove a small sample of bone from the humerus near the site of infection. The surgeon reports the biopsy as 20225. The pathologist reports the biopsy exam as 88307 (Level V - Surgical pathology, gross and microscopic examination, bone - biopsy/curettings). Use 38221 for Bone-Marrow Biopsy Important: If you report the pathologist's exam of a bone-marrow biopsy with 20220 or 20225 for the specimen extraction, you'll raise a huge red flag.

When your pathologist uses a needle or trocar to obtain a bone-marrow specimen, you should use 38221 (Bone marrow; biopsy, needle or trocar) to report the work, says Cherie Sumner, outpatient coding supervisor for University of North Carolina Hospital in Chapel Hill.

Scenario: A physician orders a bone-marrow biopsy to examine a bone lesion. The pathologist extracts the marrow and performs a pathology exam and interpretation. In this case, you would report 38221 for the extraction and 88305 (Level IV - Surgical pathology, gross and microscopic examination, bone marrow, biopsy) for the exam. Bone-Marrow Aspiration 38220 Stands Alone Although a bone-marrow aspiration and a bone-marrow biopsy may both use a needle to extract a bone-marrow specimen, the procedures have different CPT codes. The biopsy involves extracting a core of bone- marrow tissue, while during the aspiration, the physician extracts bone-marrow cells in fluid. To report a stand-alone bone-marrow aspiration, use 38220 (Bone marrow; aspiration only).

You should also code the pathologist's exam of a bone-marrow aspiration differently [...]