Pathology/Lab Coding Alert

Question: When the pathologist gets bone marrow specimens from a surgical procedure, the surgeon may call it a “biopsy” or “aspiration,” but sometimes we get both from a single procedure. How should we code the pathology exam in these cases?

New Hampshire Subscriber

Answer: CPT^® provides distinct codes for pathology exam of bone marrow aspiration and biopsy specimens, as follows:

• 88305 (Level IV - Surgical pathology, gross and microscopic examination … Bone marrow, biopsy …)
• 85097 (Bone marrow, smear interpretation)

Bone marrow is a spongy, semi-solid tissue containing fluid and cellular material. A bone marrow aspiration uses a fine gauge needle and withdraws a specimen of fluid and cells. A bone marrow biopsy uses a larger-bore hollow needle to withdraw a core of bone marrow tissue. The surgeon may withdraw either or both types of specimens in a single surgical session.

Value: The bone marrow biopsy and aspiration specimens can provide different diagnostic information for certain conditions, so taking both specimens from the same patient on the same day isn’t unusual.

The surgeon should clearly state the specimen type, and the surgeon’s procedure code can also give a clue. The following codes describe surgical extraction of bone marrow biopsy and/or aspiration specimens:

• 38220 (Diagnostic bone marrow; aspiration(s))
• 38221 (… biopsy(ies))
• 38222 (… biopsy(ies) and aspiration(s)).

Multiple codes: If the pathologist examines both an aspiration and a biopsy specimen, you should report both 88305 and 85097.

Lookout: Pathologists often prepare and evaluate a cell block from a bone marrow aspiration specimen. If you see a cell block documented in the pathology report, you should report an additional unit of 88305 (… Cell block, any source …). For a bone marrow biopsy, the pathology report might also mention “decalcification” of the biopsy specimen. If you decalcificaiton referenced, you should additionally report +88311 (Decalcification procedure (List separately in addition to code for surgical pathology examination)).