Ask the Expert

This month’s selection:

Can you offer some guidance on the new 2018 CPT code 38222, Diagnostic bone marrow; biopsy(ies) and aspiration(s)?

In the examples below, would you code 38222-53 or just for the aspiration (38220)? The planned services were for both the biopsy and aspiration; are we coding what was planned or what was completed?

Bone Marrow Biopsy and Aspiration Procedure Note Example 1:
Informed consent was obtained and potential risks including bleeding, infection, and pain were reviewed with the patient.

An appropriate time out was performed.

The left posterior iliac crest was prepped with Betadine.

4 cc of 1% Lidocaine infiltrated into the subcutaneous tissue for local anesthesia.

Left bone marrow biopsy and left bone marrow aspirate were attempted. However, it was a dry tap and a marrow biopsy could not be obtained, and the procedure was stopped.

The procedure was tolerated well and there were no complications and no blood loss. We will arrange for a biopsy through Bone Radiology.

Bone Marrow Biopsy and Aspiration Procedure Note Example 2:
Informed consent was obtained and potential risks including bleeding, infection, and pain were reviewed with the patient.

An appropriate time out was performed.

The left posterior iliac crest was prepped with Betadine.

4 cc of 1% Lidocaine infiltrated into the subcutaneous tissue for local anesthesia.

Right bone marrow biopsy and right bone marrow aspirate were attempted. However, patient was anxious and very upset and a marrow biopsy could not be obtained, and the procedure was stopped.

The procedure was tolerated well and there were no complications and no blood loss. We will arrange for a biopsy with sedation.

— A CPC at a New England hospital

Response:

New code 38222 has been created to report both diagnostic bone marrow biopsy and diagnostic bone marrow aspiration, performed at the same anatomic site, during the same encounter. This revised code series (38220, 38222) differentiates from bone marrow aspiration used for grafting or other therapeutic purposes.

In both of these cases, bone marrow aspiration and biopsy performance of the same site during the same encounter (38222) were intended, but without the desired results. Coding Clinic for HCPCS 3rd quarter 2007, pg. 10, 12, directs the coder to code procedures based on their performance and not on the desired results being obtained.

In the first scenario, the documentation supports the biopsy and aspiration procedure performed, without successful outcomes, and would be coded as 38222 since the procedure was performed.

For the second scenario, we would recommend appending the modifier 52 to code 38222. The intent of the procedure was to perform both the aspiration and biopsy of the same site; however, the biopsy was aborted. The modifier 52 signifies that the normal procedure services were reduced at the discretion of the physician or other qualified health care professional, in this case due to the patient’s anxiety. Per definition of modifier 52, the modifier would provide a means to report reduced services without disturbing the identification of the basic service.

— Tricia Jolin, RHIA, CCS-P, CPC, CIRCC, is account manager of remote services at LexiCode.

Follow-Up Question:

Just to be clear, we are to code procedures based on their performance and not on the desired results being obtained?

In example 1 we should not use the -52 modifier even though the patient had a dry tap and biopsy was not performed?

— A CPC at a New England hospital

Response:

The HCPCS CC reference noted is applicable to the scenario of a dry tap similar to the question posed. It indicates we would code it as if it performed, just not with desired results, with no modifier 52 for reduced services. I would not use this as a blanket statement that we should do this on all procedures that do not give desired results as that is going to depend on the documentation and circumstances of the encounter.

— Tricia Jolin, RHIA, CCS-P, CPC, CIRCC