Bone Marrow Studies

May 18, 2023

Bone marrow cases can be quite lengthy and include many separate potential areas that generate charges. Appropriate supporting documentation in each part of the case is necessary for complete charge capture. APS’ routine audit program for clients has uncovered many errors that can affect revenue in the form of charges billed or by putting revenue at risk due to incomplete documentation. The following outlines common bone marrow case components and required documentation or tips to support the charges:

Bone Marrow Case Component

Documentation should include:

When the pathologist performs the procedure

* “Procedure performed by Dr. ____”

* Aspirate/Core biopsy performed through same incision or separate sites

* Aspirate only or core biopsy only


Peripheral Blood Smear

* Indicate if interpretation is performed by 


Aspirate Smear

* Chargeable whether or not a differential cell 

count is part of the interpretation

Aspirate Clot Section

* Must be identified as a separate specimen 

from the aspirate smear, and is separately 



Bone Marrow Biopsy

* Preparation, examination, and diagnosis of the 


Non-intraoperative touch prep on core biopsy

* TP on the core biopsy (not the aspirate) can be 


* Commercial carriers only, can’t be billed to 




* Must be documented to be billed

* Billed once per specimen even if done on 

multiple blocks


Special Stains

* Documented each stain per block 

* Billed per block, not per specimen

Immunohistochemistry stains, qualitative

* Document each with positive or negative result

* Billed once per specimen, per antibody

Immunohistochemistry stains, quantitative

* Document each with numerical result 

(percentage or score)

* Document method as manual or 



Flow Markers

* Indicate if both technical component and 

professional components should be billed, or if the pathologist only does the interpretation 

(professional component only)

* Result of each marker should be clear for 

appropriate counting/charge capture


APS will continue to provide feedback on coding or documentation issues found commonly amongst our client base.