Fortify Your Understanding of Bone Marrow Coding
Reimbursement for aspiration and biopsy and harvesting of bone marrow rely on knowing current CPT®, Medicare, and NCCI guidance.
By Artemio Castillejos, CPC, CPMA, CCVTC, CCS, CL6SGB
As of Jan. 1, health information professionals may select specific codes for bone marrow aspiration based on purpose. Here’s what you need to know to apply these codes correctly.
Be Aware of 2018 Code Changes
To reflect standard of care changes, CPT® code descriptors for 38220 Diagnostic bone marrow; aspiration(s) and 38221 Diagnostic bone marrow; biopsy(ies) were revised, and new codes 38222 Diagnostic bone marrow; biopsy(ies) and aspiration(s) and +20939 Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure) were created to describe services more accurately.
Per the Centers for Medicare & Medicaid Services (CMS), the deletion of HCPCS Level II code G0364 is final. Instead of reporting 38221 and G0364 for bone marrow aspiration and biopsy, you should report 38222 Diagnostic bone marrow; biopsy(ies) and aspiration(s).
|+20939||Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure)||Added code|
|38220||BoneDiagnostic bone marrow; aspiration only(s)||Revised code|
|38221||BoneDiagnostic bone marrow; biopsy, needle or trocar(ies)||Revised code|
|38222||Diagnostic bone marrow; biopsy(ies) and aspiration(s)||Added code|
|G0364||Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service.||Deleted code|
Let’s look at coding rules and patient scenarios to better understand how to apply these codes correctly.
Understand Bundling Rules for Testing
Bone marrow aspiration and biopsy often are performed together at the same surgical site. Obtaining bone marrow by aspiration or sampling, described by 38220 and 38221, is for testing only, and does not include transplant purposes. When harvesting bone marrow for transplantation is done at the same time as the aspiration and biopsy, the code for bone marrow aspiration and biopsy are not separately reportable.
Example 1: The donor for a 50-year-old patient with aplastic anemia was brought to the operating room and general anesthesia was provided. To collect bone marrow from the posterior iliac crest, the provider administered approximately 400 needle sticks. After the marrow was aspirated, the needle was removed immediately. Blood was given to the donor as support, and as needed. At the end of the procedure the donor was transferred to the recovery room.
In this example, it is appropriate to report CPT® code 38230 Bone marrow harvesting for transplantation; allogeneic. You would not report the bone marrow aspiration, described by CPT® code 38220, concurrently with 38230.
NCCI Rules for Procedures Performed Alone
Report 38220 when bone marrow aspiration is performed alone, and 38221 when bone marrow biopsy is performed alone. According to National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services, Chapter 5, Section E1, codes 38220 and 38221 are reported one time only, even if the provider performs multiple aspirations or scrapings at the same insertion site.
Example 2: A 50-year-old male patient with history of leukemia presents to the facility and Dr. Smith performs a bone marrow aspiration in the left side posterior iliac crest. At the completion of the procedure, the specimen is sent for analysis. The patient returns one week later and Dr. Smith performs a bone marrow core biopsy in the left posterior iliac crest.
Report the first visit using 38220 for bone marrow aspiration performed alone. Report the second visit using 38221 for bone marrow biopsy.
Differentiate Separate Incisions
Aspiration and biopsy may be reported together only when they are performed in different bones, via a separate skin incision for the same bone, or at a separate patient encounter by the same physician on the same date of service. Modifier 59 Distinct procedural service indicates that the physician aspirated or took samples from separate sites.
Example 3: The provider performs a bone aspiration and bone biopsy on a 45-year-old male patient. After informed consent, a bone marrow is aspirated to the posterior iliac and sent for analysis. The provider performs a bone marrow sampling in the sternum, which is sent for analysis.
Because the bone marrow aspiration and bone marrow biopsy are performed at different sites on the same date of service, report 38221 and 38220, and append modifier 59 to identify the procedure is separate and distinct from the primary procedure.
According to an excerpt in the NCCI Policy Manual for Medicare Service, Chapter 5, Section E1, “CPT codes 38220 and 38221 may only be reported together if the two procedures are performed at separate sites or at separate patient encounters. Separate sites include bone marrow aspiration and biopsy in different bones or two separate skin incisions over the same bone.”
Use 38222 for Same Bone, Same Incision
When a sequenced bone marrow biopsy (38221) and bone marrow aspiration (38220) are performed through the same bone or the same skin incision over the same bone, report 38222.
Example 4: A provider performs a bone marrow biopsy and aspiration for a 77-year-old patient.
Code 38222 represents the bone marrow aspiration procedure with a bone marrow biopsy through the same incision, in the same bone, on the same date of service.
Federal Register – The Daily Journal of the United States Government – A rule by CMS, Nov. 15, 2017, “Medicare Program, Revision to Payment Policies Under the Physician Fee Schedule and Other Revision to Part B for CY 2018; Medicare Share Savings Program Requirements; and Medicare Diabetes Prevention Program.” https://federalregister.gov/d/2017-23053
Decision Health Part B News [online]. Breaking news: CPT® 2018 update delivers 4 new E/M codes, mass revisions and updates: https://pbn.decisionhealth.com/Blogs/Detail.aspx?id=200623
NCCI Policy Manual for Medicare Services, Effective Jan. 1, 2016, Chapter 5, §E1
American Medical Association, 2018 CPT® Professional Edition
Artemio Castillejos, CPC, CPMA, CCVTC, CCS, CL6SGB, is a healthcare information management professional, a license financial consultant, and an AHIMA World Congress Board Member with more than four years of experience in outsourced or offshored projects. He is a medical coding trainer at UST Global Manila Philippines. Castillejos is specialized in cardiology, cardiothoracic and vascular, evaluation and management, and surgical coding. He is a member of the Makati, Philippines, local chapter.