Pathology/Lab Coding Alert

Answer: Report aspirating a bone marrow specimen as 38220 (Bone marrow; aspiration only). The code for taking a bone marrow biopsy is 38221 (Bone marrow; biopsy, needle or trocar). Notice that these codes have been changed in CPT 2003 to make them a code family with "bone marrow" preceding the semicolon. This change clarifies what was already appropriate coding for these services you should never report together codes for both a bone marrow biopsy and aspiration from the same site. When the physician performs both procedures through the same incision, report only the more comprehensive procedure (38221) for extracting the specimens.

The same is not true for evaluating the specimens. If you evaluate both a bone marrow aspirate and a bone marrow biopsy, report each service with the appropriate code: 85097 (Bone marrow, smear interpretation) and 88305 (Level IV Surgical pathology, gross and microscopic examination, bone marrow, biopsy). Report biopsy decalcification using +88311 (Decalcification procedure [list separately in addition to code for surgical pathology examination]). Do not report the Wright's stain separately because it is a standard staining technique, not a "special stain."

Reticulum and myeloperoxidase are special stains. Report each stain once per specimen, regardless of the number of slides prepared. In your example, report the reticulum stain of the biopsy as +88313 (Special stains [list separately in addition to code for surgical pathology examination]; Group II, all other [e.g., iron, trichrome], except immunocytochemistry and immunoperoxidase stains, each). Use code 88342 (Immunocytochemistry [including tissue immunoperoxidase], each antibody) to report the myeloperoxidase aspirate stain.