How To Use CPT Code 38220

CPT 38220 describes the diagnostic bone marrow aspiration procedure, which involves the withdrawal of bone marrow tissue for diagnostic purposes. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 38220?

CPT 38220 is used to report the diagnostic bone marrow aspiration procedure. This procedure involves the insertion of a long, large-bore needle into the sternum or pelvic bone to withdraw bone marrow tissue. It is performed for diagnostic purposes only and is not intended for bone marrow transplantation.

2. Official Description

The official description of CPT code 38220 is: ‘Diagnostic bone marrow; aspiration(s).’ It is important to note that this code should not be reported in conjunction with code 38221, which is used for bone marrow biopsy procedures. Additionally, if both aspiration and biopsy are performed during the same session, code 38222 should be used.

3. Procedure

1. The provider begins by appropriately prepping and anesthetizing the patient.
2. A specially designed needle with an attached syringe is inserted through the skin, typically in the sternum or iliac crest.
3. The provider rotates the needle while pushing it into the bone marrow.
4. Once the needle is properly positioned, the provider withdraws (aspirates) the soft bone marrow tissue through the needle.
5. The collected bone marrow tissue is transferred to a container or slides for analysis.
6. The provider slowly removes the needle and applies pressure to control bleeding at the insertion site.

4. Qualifying circumstances

CPT 38220 is performed for diagnostic purposes only. It is used when the provider needs to obtain bone marrow tissue to analyze and diagnose a patient’s condition. This code should not be reported if the bone marrow aspiration is performed for transplantation purposes. It is important to note that if multiple aspirations are performed at the same insertion site, code 38220 should only be reported once. However, if aspirations are performed from separate sites, such as the iliac crest and sternum, code 38220 should be reported with modifier 59 to indicate distinct procedural service.

5. When to use CPT code 38220

CPT code 38220 should be used when the provider performs a bone marrow aspiration procedure solely for diagnostic purposes. It should not be reported if the aspiration is performed for transplantation or bone graft purposes. It is important to review the documentation and ensure that the procedure meets the criteria for diagnostic bone marrow aspiration before reporting this code.

6. Documentation requirements

To support a claim for CPT 38220, the provider must document the following information:

• Reason for the bone marrow aspiration and the need for diagnostic analysis
• Specific details of the procedure, including the site of insertion (sternum or iliac crest)
• Date of the procedure
• Confirmation of needle position and successful aspiration
• Transfer of bone marrow tissue for analysis
• Control of bleeding at the insertion site

7. Billing guidelines

When billing for CPT 38220, it is important to ensure that the procedure meets the criteria for diagnostic bone marrow aspiration. This code should not be reported in conjunction with code 38221 for bone marrow biopsy procedures. If both aspiration and biopsy are performed during the same session, code 38222 should be used. It is also important to note that some payers may limit reporting of code 38220 to only one time per day, even if multiple aspirations are performed at separate sites.

8. Historical information

CPT 38220 was added to the Current Procedural Terminology system on January 1, 2002. Since then, there have been a few historical changes to the code. On January 1, 2003, the code description was changed to specify ‘bone marrow aspiration’ instead of just ‘aspiration.’ The most recent change occurred on January 1, 2018, when the code description was further modified to specify ‘aspiration only.’

9. Examples

1. A hematologist performing a bone marrow aspiration from the sternum to diagnose a patient with suspected leukemia.
2. An oncologist performing a bone marrow aspiration from the iliac crest to evaluate a patient with unexplained anemia.
3. A pediatrician performing a bone marrow aspiration from the sternum to investigate a child with persistent fevers and abnormal blood counts.
4. An orthopedic surgeon performing a bone marrow aspiration from the iliac crest to assess a patient with suspected bone marrow involvement in metastatic cancer.
5. An internist performing a bone marrow aspiration from the sternum to evaluate a patient with unexplained thrombocytopenia.
6. A rheumatologist performing a bone marrow aspiration from the iliac crest to investigate a patient with suspected systemic lupus erythematosus.
7. An infectious disease specialist performing a bone marrow aspiration from the sternum to diagnose a patient with suspected tuberculosis.
8. A hematologist performing a bone marrow aspiration from the iliac crest to evaluate a patient with unexplained pancytopenia.
9. An oncologist performing a bone marrow aspiration from the sternum to assess a patient with suspected lymphoma.
10. A pediatric hematologist performing a bone marrow aspiration from the iliac crest to investigate a child with unexplained neutropenia.