Bone marrow aspiration and biopsy codes received updates in CPT® 2018 that significantly change how the services are reported.

Existing codes 38220 and 38221 were revised:

38220 Bone Diagnostic bonemarrow; aspirationonly(s)

38221 Bone Diagnostic bonemarrow; biopsy, needle or trocar(ies)

Note: To demonstrate the updates for 2018, new text is underlined and deleted text is struck through.

Code 38220 now specifies that the procedure may include any number of aspirations, and the plural option “ies” is added to biopsy in the descriptor for 38221 to indicate any number of biopsies included as part of the procedure.

CPT® 2018 also introduced a new code to report bone marrow aspiration and biopsy performed during the same encounter:

38222 Diagnostic bone marrow; biopsy(ies) and aspiration(s)

CPT® guidelines tell us not to report 38222  with 38220 or 38221 (because both biopsy and aspiration are included in 38222). Additionally, you should never report 28220 and 38221 together to report biopsy and aspiration at the same location: in such a case, 38222 is appropriate.

You may report 38220 and 328221 together if the aspiration and biopsy occur at different locations. The NCCI Policy Manual, Chapter 1 (updated Jan. 1, 2018) explains:

The column one/column two code edit with column one CPT code 38221 (Diagnostic bone marrow biopsy) and column two CPT code 38220 (Diagnostic bone marrow, aspiration) includes two distinct procedures when performed at separate anatomic sites (e.g., contralateral iliac bones) or separate patient encounters. In these circumstances, it would be acceptable to use modifier 59. However, if both 38221 and 38220 are performed on the same iliac bone at the same patient encounter which is the usual practice, modifier 59 shall NOT be used. Although CMS does not allow separate payment for CPT code 38220 with CPT code 38221 when bone marrow aspiration and biopsy are performed on the same iliac bone at a single patient encounter, a physician may report CPT code 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)).

The following “Examples of CPT assignment,” were published by APS Medical Billing (January 2018)http://apsmedbill.com/sites/default/files/whitepaper/bone_marrows_2018.pdf

1)  A 60 year old female with known acute myeloid leukemia with rare circulating blasts requires bone marrow aspirate for assessment of relapse and clonal evolution.

CODE 38220

2)  A 60 year old male female with newly diagnosed Hodgkin’s disease presents with adenopathy and fever. The patient requires a bone marrow biopsy for staging to determine bone marrow involvement.

CODE 38221

3) A 60 year old male presents with peripheral blood pancytopenia with nondiagnostic iron studies and level B12. The patient requires both a bone marrow biopsy and aspiration.
The physician makes a small incision, inserts the bone marrow aspiration needle to the bone surface and drills the needle into the iliac crest marrow space. Bone marrow is aspirated. If necessary, the needle is placed again until adequate spicules are identified. Additional aspirates are obtained for cultures, flow, cytogenetics and molecular studies. Next, through the same incision a biopsy needle is introduced and a bone marrow biopsy is taken and assessed. If adequate, the needle is removed. Procedure complete.

CODE 38222

In addition to the above CPT® changes, HCPCS code G0364 Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of servicewas retired, as of Jan. 1, 2018. Previously, G0364 was used in addition to the biopsy code (38221) for Medicare billing when both a needle biopsy and aspiration of bone marrow were performed via the same access.