Oncology & Hematology Coding Alert

Question: How is a bone marrow aspiration different from a bone marrow biopsy?

Ohio Subscriber

Answer: Bone marrow consists of fluid and the bone marrow itself, which is a solid, spongy tissue.

A provider will obtain a sample of bone marrow for a biopsy to determine the status of such conditions as blood cell diseases like leukopenia or thrombocytopenia, blood cancers like leukemias or lymphomas, or cancers that have metastasized into the bone marrow itself.

Both procedures are performed using different-sized needles: a smaller, hollow one to withdraw the fluid using a syringe, and a larger one to remove a core sample of the bone marrow. The sample is most often taken from the patient’s pelvic bone.

To report the aspiration, you would report 38220 (Diagnostic bone marrow; aspiration(s)); for the biopsy, 38221 (Diagnostic bone marrow; biopsy(ies)). However, when the two procedures are performed together, which commonly happens, you would use 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)), providing the procedures are performed at the same anatomic site.

You may report multiple aspirations or biopsies if they are performed at separate sites, such as the left and right sides of the pelvis, by appending modifier 59 (Distinct procedural service) or modifier XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) to the second 38220 or 38221 if your payer is Medicare or a payer that requires use of Medicare X{ESPU} modifiers.