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Procedure performed for Cpt code bone marrow biopsy & aspiration

A bone biopsy is a procedure to obtain sample bone tissue to further analyze a suspected medical condition or infection. Cpt code for bone marrow biopsy and aspiration is coded frequently in coding biopsy charts. After administration of adequate anesthesia, the operative area is prepped and draped. The physician examines the area to be biopsied. Using a scalpel a small percutaneous incision is made over the targeted area.

A large diameter biopsy needle or bone trocar is advanced through the percutaneous stab incision. After proper localization of the biopsy tool at the bone level, the soft bone tissue is debrided and pulled. The removed bone sample is preserved and processed for further laboratory examination. The incision is closed. We have learned about Fine Needle aspiration coding in previous post but now we will learn about Cpt code for bone marrow biopsy and aspiration.

When to use Cpt code 20220 & 20225

For this exam, the physician usually performs a biopsy on bone to confirm a suspected growth, disease, or infection. The physician normally uses local anesthesia; however, general anesthesia may be used. The physician places a large needle into the spinous process or other superficial bone to obtain the sample in CPT code 20220. For sampling a deeper lying bone, such as a vertebra in CPT code 20225, an exploring needle is passed through a larger needle to the desired depth and a piece of tissue is removed for testing.

Different approaches are taken for vertebral biopsies, based on differing levels of vertebrae. The top three cervical vertebrae are approached from a pharyngeal or anterior approach. The lower four cervical vertebrae are approached from a lateral direction. Thoracic and lumbar vertebra are approached from behind and to the right to avoid major arteries. Radiographs are sometimes used to confirm the placement of the needle.

Do not use 20220 / 20225 for a bone marrow biopsy. These codes are for bone biopsy only.

Coding Guide for Axillary lymph node biopsy CPT code

When to use CPT code 38220 and 38222

In CPT code 38220, diagnostic bone marrow aspiration is performed with bone marrow samples usually taken from the pelvic bone or sternum. The skin over the bone is cleaned with an antiseptic solution. A local anesthetic is injected and the physician inserts a needle beneath the skin and rotates it 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. If more marrow is needed, the needle is repositioned slightly, a new syringe is attached, and a second sample is taken. In CPT code 38221, diagnostic bone marrow biopsies are performed.

The skin over the bone is cleaned with an antiseptic solution. A local anesthetic is injected and the needle is inserted, rotated to the right, rotated to the left, withdrawn, and reinserted at a different angle. This procedure is repeated until a small chip is separated from the bone marrow. The needle is again removed, and a piece of fine wire threaded through its tip transfers the specimen onto gauze. Samples contain bone marrow of which the structure has not been disturbed or destroyed. The bone must be decalcified overnight before it can be properly stained and examined. In both procedures, samples are transferred from the syringes to slides and sent to a laboratory for analysis. CPT code 38222 is reported when both bone marrow biopsies and aspirations are performed.

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.

Clinical Scenario for Cpt code for bone marrow biopsy and aspiration

1. Question: Our oncologist wants to report 85097 when he takes a bone biopsy, looks at the sample, prepares a brief report, and then sends the sample to pathology. In this situation, should I report 85097 for the oncologist’s services?

Answer: No. If both the oncologist and the lab report the same code for the same service, the payer will pay only one. In the case you describe, the lab that provides the formal evaluation and report should submit the lab service code. Because the oncologist performed the “bone biopsy,” as you describe it, the oncologist should submit a claim for that service.

Service check: Verify the precise service your oncologist performed before submitting your claim: bone marrow aspiration, bone marrow biopsy, or bone biopsy. Your question refers to 85097 (Bone marrow, smear interpretation), which is the lab code for pathology exam of a bone marrow aspiration– not biopsy. If the oncologist performs a bone marrow aspiration, you should report 38220 (Bone marrow; aspiration only).

If the oncologist instead performs a bone marrow biopsy, you should report 38221 (… biopsy, needle, or trocar). The lab likely will report 88305 (Level IV– Surgical pathology, gross and microscopic examination, bone marrow, biopsy) for the biopsy evaluation.

For a biopsy of the actual bone, review the bone biopsy codes from 20220-20251 (Biopsy …), and choose the most accurate code. The lab’s code for the bone biopsy examination is 88307 (Level V– Surgical pathology, gross and microscopic examination, bone– biopsy/curettings).

Coding guide for Capsulorrhaphy CPT code 29806

Coding tips for CPT code 38220, 38221 or 38222

When diagnostic bone marrow aspiration(s) and/or biopsy(ies) are performed bilaterally, this is not considered a same anatomic site, and it is appropriate to report code 38220, 38221, or 38222 and append modifier 50, Bilateral Procedure. Although the use of modifier 50 with these codes reflects the intent of the CPT coding system, individual third-party payers may have differing policy for the reporting of bilateral procedures.

The following rules apply to reporting code 38220, 38221 or 38222 for diagnostic bone marrow aspiration and/or bone marrow biopsy(ies):

Code 38220 is reported when a diagnostic bone marrow aspiration is performed to obtain diagnostic material for pathologic testing. If both diagnostic aspiration and biopsy are performed at the same anatomic site, code 38222 is reported. Multiple diagnostic bone marrow aspirations obtained at the same anatomic site may not be reported separately. If aspirations are performed at different anatomic sites, modifier 59, Distinct Procedural Service, should be appended to code 38220.
Code 38221 is reported when a diagnostic bone marrow biopsy is performed. If both diagnostic aspiration and biopsy are performed at the same anatomic site, code 38222 is reported. Multiple diagnostic bone marrow biopsies obtained at the same anatomic site may not be reported separately. If biopsies are performed at different anatomic sites, modifier 59 should be appended to code 38221.
Code 38222 is reported when both diagnostic bone marrow aspiration and biopsy are performed during the same patient encounter. The Healthcare Common Procedure Coding System (HCPCS) code G0364 has been deleted and should not be reported for this service.
Multiple diagnostic bone marrow aspirations and biopsies obtained at the same anatomic site may not be reported separately. If aspirations and biopsies are performed at different anatomic sites, modifier 59 should be appended to code 38222.
Both codes 38220 and 38221 should not be reported for the same patient encounter for obtaining diagnostic bone material for pathologic testing.
For pathologic testing of diagnostic bone marrow aspiration and biopsy samples, report the appropriate pathologic testing codes.

Reader Question: 62267 Applies to Discitis Biopsy

Question: Which code should we use for intervertebral disc biopsy for discitis? I’m considering 20220, 62267, or 62269.
Answer: Your best choice is 62267 (Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes). If the physician used fluoroscopic guidance, also report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural or subarachnoid]).

You should include the appropriate diagnosis from 722.9x (Other and unspecified disc disorder) for the discitis. The codes in this family are delineated by region (unspecified, lumbar, thoracic, or cervical), so verify the anatomic site to select the best diagnosis. The corresponding ICD-10 codes are even more site specific:

M46.40, Discitis, unspecified, site unspecified
M46.41, Discitis, unspecified, occipito-atlanto-axial region
M46.42, Discitis, unspecified, cervical region M46.43, Discitis, unspecified, cervicothoracic region
M46.44, Discitis, unspecified, thoracic region
M46.45, Discitis, unspecified, thoracolumbar region
M46.46, Discitis, unspecified, lumbar region
M46.47, Discitis, unspecified, lumbosacral region
M46.48, Discitis, unspecified, sacral and sacrococ cygeal region
M46.49, Discitis, unspecified, multiple sites in spine.

Caution: You mentioned you were also considering whether 20220 (Biopsy, bone, trocar, or needle; superficial [e.g., ilium, sternum, spinous process, ribs]) or 62269 (Biopsy of spinal cord, percutaneous needle) would apply to this situation. These codes would not be appropriate. Code 20220 refers to a bone biopsy, and the intervertebral disc is not a bone. Also, the descriptor for 20220 applies to a “superficial” procedure, which is less involved than an “intervertebral disc biopsy.” Code 62269 would not apply because you’re coding for a biopsy of the intervertebral disc instead of the spinal cord. The spinal cord is not the same anatomically as an intervertebral disc.