Bone Marrow Procedure Codes for 2018

January 8, 2018

Effective January 1, 2018 new CPT code 38222 (Diagnostic bone marrow; biopsy (ies) and aspiration(s)) will be reported and combines the two procedures into a single code.  This was added to CPT text to simplify reporting when both procedures are performed.

Code 38220 and 38221 have been revised to accommodate separate reporting and to reflect that both procedures are diagnostic procedures.  Code 38220 now notes that any number of aspirations are included as part of the procedure.  For code 38221, the phrase “needle or trocar” has been removed and the optional plural “ies” has been added to biopsy to indicate that any number of biopsies performed are included as part of the procedure.

38220 Diagnostic bone marrow; aspiration(s)
(Do not report 38220 in conjunction with 38221)
(For diagnostic bone marrow biopsy [ies] and aspiration[s] performed at the same session, use 38222)

38221  biopsy (ies)
(Do not report 38221 in conjunction with 38220)
(For diagnostic bone marrow biopsy [ies] and aspiration[s] performed at the same session, use 38222)

38222  biopsy (ies) and aspiration(s)
(Do not report 38222 in conjunction with 38220 and 38221)
(For bilateral procedure, report 38220, 38221, and 38222 with modifier 50)
(For bone marrow biopsy interpretation, use 88305)

On January 1, 2018, the long-utilized HCPCS code G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) has been retired.  This was used for Medicare billing when both a needle biopsy and aspiration of bone marrow were performed through the same access site.  It was an add-on code reported in addition to the code for the biopsy (38221).

Examples of CPT assignment:
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       

The following resources were used in the preparation of this document: the AMA's Current Procedural Terminology (CPT) 2018 and CPT 2018 Changes-An Insider's View.