How To Use CPT Code 38221

CPT 38221 describes the procedure for diagnostic bone marrow biopsy performed by a healthcare provider. 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 38221?

CPT 38221 is used to describe the diagnostic bone marrow biopsy procedure performed by a healthcare provider. This code is used when the provider takes one or more samples of bone marrow from the sternum or pelvic bone for diagnostic purposes only. It is important to note that this code should not be reported if the provider is also harvesting bone marrow for transplantation.

2. Official Description

The official description of CPT code 38221 is: ‘Diagnostic bone marrow; biopsy(ies).’ It is important to note that this code should not be reported in conjunction with CPT code 38220, which is used for bone marrow aspiration for diagnostic purposes.

3. Procedure

1. The healthcare provider prepares the patient and administers anesthesia if necessary.
2. The provider inserts a trocar down to the bone or cuts a small opening into the bone, typically in the sternum or iliac crest.
3. A small amount of bone marrow is scraped or excised from the bone.
4. The provider transfers the bone marrow sample to a container or slide for analysis.
5. The provider removes the trocar or bone blade and covers the bone defect.
6. The provider may close the skin incision with a single suture or adhesive strips.

4. Qualifying circumstances

CPT 38221 is performed when a healthcare provider needs to obtain bone marrow samples for diagnostic purposes. This procedure is typically performed on patients who require further evaluation of their blood cells or bone marrow for various medical conditions. It is important to note that this code should not be reported if the provider is also harvesting bone marrow for transplantation.

5. When to use CPT code 38221

CPT code 38221 should be used when a healthcare provider performs a diagnostic bone marrow biopsy procedure for the purpose of obtaining bone marrow samples for analysis. It is important to note that this code should not be reported if the provider is also harvesting bone marrow for transplantation.

6. Documentation requirements

To support a claim for CPT 38221, the healthcare provider must document the following information:

• Reason for performing the diagnostic bone marrow biopsy
• Location of the bone marrow biopsy (sternum or iliac crest)
• Details of the procedure, including the use of anesthesia if applicable
• Amount of bone marrow obtained for analysis
• Transfer of the bone marrow sample to a container or slide
• Closure of the skin incision, if applicable

7. Billing guidelines

When billing for CPT 38221, ensure that the procedure meets the criteria for a diagnostic bone marrow biopsy. It is important to note that this code should not be reported if the provider is also harvesting bone marrow for transplantation. Additionally, do not report CPT 38221 in conjunction with CPT code 38220, which is used for bone marrow aspiration for diagnostic purposes.

8. Historical information

CPT 38221 was added to the Current Procedural Terminology system on January 1, 2002. There have been historical changes to the code, including code changes in 2003 and 2018.

9. Examples

1. A hematologist performing a diagnostic bone marrow biopsy on a patient with suspected leukemia.
2. An oncologist obtaining bone marrow samples from the sternum for further evaluation of a patient’s lymphoma.
3. A pediatrician performing a diagnostic bone marrow biopsy on a child with unexplained anemia.
4. An internist performing a bone marrow biopsy to investigate the cause of a patient’s abnormal blood cell counts.
5. A hematopathologist performing a diagnostic bone marrow biopsy to assess the progression of a patient’s myelodysplastic syndrome.
6. An orthopedic surgeon obtaining bone marrow samples from the iliac crest for analysis in a patient with suspected bone marrow pathology.
7. A hematologist performing a diagnostic bone marrow biopsy to evaluate a patient’s response to chemotherapy for multiple myeloma.
8. An oncology nurse assisting a healthcare provider in performing a bone marrow biopsy on a patient with suspected lymphoma.
9. A pathologist analyzing bone marrow samples obtained through a diagnostic biopsy to determine the presence of abnormal cells.
10. A hematologist performing a diagnostic bone marrow biopsy to investigate the cause of a patient’s unexplained thrombocytopenia.