Secret tips for Cpt code for bone marrow biopsy and aspiration

Secret tips for Cpt code for bone marrow biopsy and aspiration
Bone marrow biosy (Photo credit: Wikipedia)

Procedure performed for Cpt code for bone marrow biopsy and aspiration

A bone biopsy is a procedure to obtain sample bone tissue to further analyze a suspected medical condition or infection. Cpt code for bone marrow biopsy and aspiration is coded commonly with other biospies like breast biopsy. Unlike, breast needle core biopsy CPT codes Bone and bone marrow biopsy are not divided on the basis of guidance. Let us first check how the procedure is performed. After administration of adequate anesthesia, the operative area is prepped and draped. The physician examines the area to be biopsied. Using a scalpel a small percutaneous incision is made over the targeted area. A large diameter biopsy needle or bone trocar is advanced through the percutaneous stab incision. After proper localization of the biopsy tool at the bone level, the soft bone tissue is debrided and pulled. The removed bone sample is preserved and processed for further laboratory examination. The incision is closed. We have learned about Fine Needle aspiration coding in previous post but now we will learn about Cpt code for bone marrow biopsy and aspiration.

Tips for Cpt code for bone marrow biopsy and aspiration

Do not use 20220 / 20225 for a bone marrow biopsy. These codes are for bone biopsy only.
Important: If you report the pathologist's exam of a bone-marrow biopsy with 20220 or 20225 for the specimen extraction, you'll raise a huge red flag. When your pathologist uses a needle or trocar to obtain a bone-marrow specimen, you should use 38221 (Bone marrow; biopsy, needle or trocar) to report the work.

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  Scenario for Cpt code for bone marrow biopsy and aspiration

1. Question: Our oncologist wants to report 85097 when he takes a bone biopsy, looks at the sample, prepares a brief report, and then sends the sample to pathology. In this situation, should I report 85097 for the oncologist's services?

Answer: No. If both the oncologist and the lab report the same code for the same service, the payer will pay only one. In the case you describe, the lab that provides the formal evaluation and report should submit the lab service code. Because the oncologist performed the "bone biopsy," as you describe it, the oncologist should submit a claim for that service.

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Service check: Verify the precise service your oncologist performed before submitting your claim: bone marrow aspiration, bone marrow biopsy, or bone biopsy. Your question refers to 85097 (Bone marrow, smear interpretation), which is the lab code for pathology exam of a bone marrow aspiration-- not biopsy. If the oncologist performs a bone marrow aspiration, you should report 38220 (Bone marrow; aspiration only).

If the oncologist instead performs a bone marrow biopsy, you should report 38221 (… biopsy, needle, or trocar). The lab likely will report 88305 (Level IV-- Surgical pathology, gross and microscopic examination, bone marrow, biopsy) for the biopsy evaluation.
For a biopsy of the actual bone, review the bone biopsy codes from 20220-20251 (Biopsy …), and choose the most accurate code. The lab's code for the bone biopsy examination is 88307 (Level V-- Surgical pathology, gross and microscopic examination, bone-- biopsy/curettings).

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Question: Which code should we use for intervertebral disc biopsy for discitis? I’m considering 20220, 62267, or 62269.

Answer: Your best choice is 62267 (Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes). If the physician used fluoroscopic guidance, also report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural or subarachnoid]).
You should include the appropriate diagnosis from 722.9x (Other and unspecified disc disorder) for the discitis. The codes in this family are delineated by region (unspecified, lumbar, thoracic, or cervical), so verify the anatomic site to select the best diagnosis. The corresponding ICD-10 codes are even more site specific:
  • M46.40, Discitis, unspecified, site unspecified
  • M46.41, Discitis, unspecified, occipito-atlanto-axial region
  • M46.42, Discitis, unspecified, cervical region M46.43, Discitis, unspecified, cervicothoracic region
  • M46.44, Discitis, unspecified, thoracic region
  • M46.45, Discitis, unspecified, thoracolumbar region
  • M46.46, Discitis, unspecified, lumbar region
  • M46.47, Discitis, unspecified, lumbosacral region
  • M46.48, Discitis, unspecified, sacral and sacrococ cygeal region
  • M46.49, Discitis, unspecified, multiple sites in spine.
Caution: You mentioned you were also considering whether 20220 (Biopsy, bone, trocar, or needle; superficial [e.g., ilium, sternum, spinous process, ribs]) or 62269 (Biopsy of spinal cord, percutaneous needle) would apply to this situation. These codes would not be appropriate. Code 20220 refers to a bone biopsy, and the intervertebral disc is not a bone. Also, the descriptor for 20220 applies to a “superficial” procedure, which is less involved than an “intervertebral disc biopsy.” Code 62269 would not apply because you’re coding for a biopsy of the intervertebral disc instead of the spinal cord. The spinal cord is not the same anatomically as an intervertebral disc.

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15 June 2014 at 11:39 delete

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