Listed Codes for coverage

Each provider is legally responsible to ensure that all coding for reimbursement under federal reimbursement or commercial programs is recorded and submitted appropriately and within the legal and contractual parameters permissible for reimbursement or coverage of such services.

Vidacare is providing the information below to assist in this process, but disclaims any liability for the accuracy or appropriate use of such coding. In addition, the information below does not constitute legal or medical advice nor does Vidacare assume any liability for updating this information as new or different coding information becomes available.

Bone Marrow Aspiration and Biopsy; and Powered Bone Marrow Biopsy may be reported using the following HCPCS codes:

Bone Marrow, Aspiration only	CPT Code 38220
Bone Marrow, Biopsy, Needle or Trocar	CPT Code 38221
Bone Marrow Aspiration performed with Bone Marrow Biopsy through the same incision at the same date of service	G0364 (Medicare use)
Power Bone Marrow Biopsy Needle	C1830

• Per Medicare guidelines, as outlined in the National Correct Coding Initiative Policy Manual, Chapter 5, Section E, when bone marrow aspiration is performed alone, the appropriate code to report is CPT code 38220.
• When a bone marrow biopsy is performed alone, the appropriate code to report is CPT Code 38221. CPT code 38221 cannot be reported with CPT code 20220 (bone biopsy).
• 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 with two separate skin incisions over the same bone.
• When a bone marrow biopsy (CPT code 38221) and bone marrow aspiration (CPT code 38220) are performed at the same site through the same skin incision, report only CPT code 38221.

Use of CPT code modifier “59” (distinct procedural service) – Medicare

Use of CPT code modifier “59” appended to CPT codes 38220 and 38221 should only be used if the two procedures are performed at separate sites or during separate patient encounters. If the procedures occur through the same incision, one should not use modifier “59” to report 38220 and 38221 together to Medicare. For sequenced procedures through the same incision, HCPCS code G0364 should be used. In this case, report CPT code 38221 for the biopsy as usual. The aspiration should then be reported using HCPCS code G0364

(Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service).

Coding with commercial insurers

Providers should contact their payer for specific coverage guidelines before submitting claims for bone marrow aspiration and biopsy. Some commercial and managed care payers may have guidelines that allow one to report 38220 and 38221 for sequenced procedures. Others may require you to report only the most extensive procedure.

Coding for imaging services while performing a bone marrow biopsy and/or aspiration

According to the American College of Radiology, image guidance for all of these procedures refers to the use of an imaging modality to identify the exact location of the area to be treated or sampled. The imaging is also used to ensure that the needle is placed in the correct location to obtain the biopsy. For most drainage, aspiration, and biopsy procedures, the work and cost of imaging is not included in the base code and should be reported separately. Imaging for needle placement is paid in addition to the biopsy/aspiration procedure.

Biopsy and aspiration guidance can be performed with fluoroscopy, ultrasound, or CT using the following CPT codes:

Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device)	CPT Code 77002
Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation	CPT Code 76942
Computed tomography guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), radiological supervision and interpretation	CPT Code 77012

The choice of modality for imaging guidance depends on the site and characteristics of the fluid collection or lesion. Whatever modality is utilized, documentation of needle tip location in the physician notes is necessary, according to the American College Radiology Practice Guidelines.