The 2018 Medicare final regulations, code updates, and other changes have impacted many healthcare specialties. As of January 1, 2018, there are new codes, revised codes, and updates to coding guidelines for bone marrow procedures and medical coding outsourcing is a viable strategy to ensure compliance with the new coding and billing guidelines.
Inspection of bone marrow is considered an important diagnostic tool for evaluating hematologic disorders. While bone marrow aspiration removes a small amount of marrow, a bone marrow biopsy removes a small amount of bone with the marrow.
Starting January 1, 2018, there are new CPT code descriptors for 38220 Diagnostic bone marrow; aspiration(s) and 38221 Diagnostic bone marrow; biopsy(ies) as well as new codes to describe services more accurately.
Revised codes
CPT codes 38220 and 38221 have been redefined to accommodate separate reporting and to reflect that both are diagnostic procedures.
- 38220 Diagnostic bone marrow; aspiration(s)
- 38221 Diagnostic bone marrow; biopsy, needle or trocar(ies)
New codes
To describe services more accurately, there is a new add-on code 20939 for reporting bone marrow aspiration for spine surgery.
- +20939 Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure)
Add-on code 20939 is exclusively meant for use by orthopedic surgeons and neurosurgeons doing spine autograft procedures.
An AAPC blog explains: “CPT 20939 describes harvesting bone marrow which involves performing a corticotomy, often with a trephine, in order to gain access to and withdraw the bone marrow, comprised of both hematogenous and trabecular bone tissue. The procedure requires targeting, confirmation of position, and retrieval/acquisition of bone marrow to mix with allograft”.
The spinal fusion codes that are the base codes for 20939 include the following: 22319, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22590, 22595, 22600, 22610, 22612, 22630, 22633, 22634, 22800, 22802, 22804, 22808, 22810, and 22812.
- 38222 Diagnostic bone marrow; biopsy(ies) and aspiration(s)
CPT 38222 is another new code that was created to describe a diagnostic bone marrow procedure that bundles biopsy and aspiration into one code.
Deleted code
G0364 Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service
As 38222 accurately describe the services currently reported by G0364, HCPCS code G0364 has been deleted.
Guidelines for Using the New Codes
To report aspiration and biopsy and harvesting of bone marrow, providers need to understand the bundling rules:
- CPT code 38220 should be reported when bone marrow aspiration is performed alone, and code 38221 when bone marrow biopsy is performed alone.
- Do not report 38220 in conjunction with 38221
- CPT codes 38220 and 38221 describe obtaining bone marrow by aspiration or sampling for testing (diagnostic) purposes only and do not involve transplant purposes.
- For bone marrow harvesting for transplantation, report CPT code 38230 Bone marrow harvesting for transplantation; allogeneic.
- CPT codes 38220 and 38221 are not separately reportable when harvesting bone marrow for transplantation is done at the same time as the aspiration and biopsy, that is, do not report 38220 or 38221 in conjunction with 38230.
- According to National Correct Coding Initiative (NCCI) guidelines, CPT codes 38220 and 38221 should be reported only one time, even if multiple aspirations or scrapings are performed at the same insertion site.
- The NCCI policy manual states that “CPT codes 38220 and 38221 may only be reported together if the two procedures are performed at separate sites or at separate patient encounters.” Separate sites include bone marrow aspiration and biopsy in different bones or two separate skin incisions over the same bone. Modifier 59 Distinct procedural service should be appended to indicate that the physician aspirated or took samples from separate sites.
- Code 38222 should be reported when the bone marrow aspiration procedure and a bone marrow biopsy are performed through the same incision, in the same bone, on the same date of service.
- For a bilateral procedure, report 38220, 38221 and 38222 with modifier 50.
- CPT code 88305 (tissue exam by pathologist) is used to report bone marrow biopsy interpretation.
Up to date with the latest CPT, Medicare, and NCCI guidelines, experienced medical coding companies can help physicians ensure proper reimbursement for bone marrow aspirations and biopsies.
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