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Basics of CPT code for bone marrow biopsy/aspiration

A bone marrow biopsy procedure is performed to remove a small amount of bone and a small amount of fluid and cells from inside the bone (bone marrow). While a bone marrow aspiration is performed to remove only the marrow. We have learnt about thyroid biopsy, lung biopsy, breast biopsy procedure coding. Here, also we have separate CPT code for bone marrow biopsy and aspiration.

In diagnostic bone marrow aspiration, the bone marrow sample are usually taken from the pelvic bone or sternum. CPT code 38220, is used to report for diagnostic bone marrow aspiration. Before performing the procedure, the whole skin over the bone is cleaned with an antiseptic solution. Then by injecting local anesthesia, the physician insert a needle beneath the skin and rotates until the needle penetrates the cortex. At least 2.5 cc of marrow is aspirated out of the bone by a syringe attached to the needle. For Fine Needle aspiration procedure also we have separate CPT codes.

In diagnostic bone marrow biopsies, the same procedure is repeated and only a sample of bone and fluid is removed from inside the bone (bone marrow). CPT code 38221 is reported for coding for bone marrow biopsy.

When both bone marrow biopsy and bone marrow aspiration is performed at the same session, a new CPT code 38222 has been added in 2018 to report both the procedures together.

Code description for CPT code 38220, 38221 and 38222

We are familiar with CPT code 38220 and 38221, but in 2018 we have a new procedure code 38222 for coding both procedure (bone marrow biopsy and aspiration together). Below is the detail code description for these procedure codes.

38220 Diagnostic bone marrow; aspiration(s)

38221 Diagnostic bone marrow; biopsy(ies)

38222 Diagnostic bone marrow; biopsy(ies) and aspiration(s)

There are some related bone biopsy procedure code as well for superficial and deep bone.

20220 Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs)

20225 Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur)

On January 1, 2018, the long-utilized HCPCS code G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) has been deleted. This was used for Medicare billing when both a needle biopsy and aspiration of bone marrow were performed through the same access site. It was an add-on code reported in addition to the code for the biopsy (38221).

Do and Don’t for CPT code 38220, 38221 and 38222

Do not report 38220 in conjunction with 38221

When diagnostic bone marrow biopsy(ies) and aspiration(s) performed at same session use cpt code 38222.

In the unusual circumstance when an aspiration is performed at one site, and a biopsy is performed at a completely separate site (e.g., right and left iliac crests or sternum), report codes 38220-59 and 38221.