Pathology/Lab Coding Alert

Question: A pathologist performs a bone marrow aspiration, examines direct smears, processes a clot from the remaining aspirate, and examines an iron stain on both the aspirate and the clot. How should we code the case?

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Answer: This case involves multiple procedures, and you should code each one separately. You must ensure that the pathology report documents each individual service.
 
For the bone marrow aspirate extraction, use CPT 38220 (Bone marrow; aspiration only). This service involves removing bone-marrow cells through a needle, and a surgeon may do the work. Don't bill for 38220 unless the pathology report documents that the pathologist actually performed the extraction.
 
The pathologist's work to evaluate the bone-marrow aspirate is 85097 (Bone marrow, smear interpretation).
 
To process and evaluate the clot, you should report that the pathologist performed 88305 (Level IV -- Surgical pathology, gross and microscopic examination, cell block, any source) in addition to the 85097 exam.
 
If the pathologist examined iron stains for both the bone-marrow aspirate and the clot, you should code two units of +88313 (Special stains [list separately in addition to code for primary service]; group II, all other [e.g., iron, trichrome], except immunocytochemistry and immunoperoxidase stains, each). You should use the special stain code per specimen, not per slide.