Bone Marrow Aspiration Coding


Anchorage, Alaska
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Our Podiatrist performed a bone marrow aspiration and a portion of the op note is below:

Procedure 3 cotton osteotomy right foot medial cuneiform:
Attention was then drawn to the dorsal aspect of the right foot where a 5 cm was generated over the medial cuneiform. Dissection was carried down to the level of the periosteum of the medial cuneiform using a combination of sharp and blunt dissection. Transverse osteotomy was performed, and a metatarsal spreader was used to help relax the soft tissues on the plantar most surface of the medial cuneiform. A Hintermann was introduced to allow for enhanced distraction and a size 6 cotton wedge bone graft was introduced to the medial cuneiform. Prior to doing so, 3 mL of bone marrow aspirate was introduced into the osteotomy site, bathing both the graft as well as the inferior surface. Temporary fixation came in the form of a 0.062 K-wire that was introduced proximal to distal. The wound was irrigated and closed. Prior to doing so, bone putty osteoconductive material was packed around the graft.

Procedure 6 bone marrow aspiration right heel:
Prior to insufflation of the tourniquet, a Jamshidi needle was introduced to the lateral aspect of the body of the tuberosity of the calcaneus. Under negative pressure, 5 mL of bone marrow aspirate was obtained for introduction to both the calcaneal osteotomy as well as the cotton osteotomy site. Once the bone marrow aspirate was obtained, the wound was irrigated and closed in the usual fashion. The patient was then taken to the PACU with neurovascular status intact to the right foot and ankle. The patient tolerated the procedure and the anesthesia well.

There is disagreement in our office as to what the bone marrow aspiration should be coded as:
38220 which the Coder's Desk Reference says is diagnostic and sent out to be analyzed which he did not do
38232 which is more for harvesting for use in an actual transplant
0232T PRP which can be by blood or bone marrow but he did not state he spun it down

Any help would be appreciated


True Blue
Salt Lake City, UT
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You see this on repairs. It's not PRP.

After a repair the surgeon can inject bone marrow aspirate to help facilitate the healing process. While there is no code for injecting it, you can bill for obtaining the bone morrow with 38220. This will usually be done at a different site.


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Bone marrow aspiration code 38220 changed as of Jan 1 2018 and it now states it is for diagnostic purposes only. So it should not be used for what you are describing.

Under CPT code 20939 in your Professional Addition CPT book it states for bone marrow aspiration other than spinal procedures you are to use 20999.