Oncology & Hematology Coding Alert

Need direction on how to educate your oncologist regarding unbundling 38220 (Bone marrow; aspiration only) and 38221 (... biopsy, needle or trocar) with one incision and two withdrawal accesses? Then learn by example. The following sample report provided by Martin Neltner, president of Neltner Billing & Consulting in Independence, Ky., illustrates how your physician should document these two procedures.
 
Procedure: Bone marrow aspiration and biopsy
 Site: Left posterior superior iliac crest
 Local anesthesia: 1% percent Xylocaine
 Procedure notes: Your oncologist explained the procedure to the patient and obtained the patient's consent. Then your oncologist placed the patient in position, and identified the left superior iliac crest. Your physician proceeded to clean the crest with Betadine. Then your oncologist applied local anesthesia to the skin, subcutaneous tissue and periosteum.
 
First using an Illinois needle, your physician conducted the aspiration and withdrew the needle. Next, he or she selected a site a few millimeters away from the first needle puncture. Your oncologist lanced the skin and performed a second pass to obtain the biopsy with a Jamshidi needle. Afterward your oncologist sent the core to the lab. The patient tolerated the procedure well. Your oncologist observed the patient in the clinic for about 20 minutes before he or she discharged the patient.