Know When CCI Manual Says to Use Bone Marrow Code 38222

bone marrow biopsy, aspiration, or both?

The addition of diagnostic bone marrow and biopsy code 38222 in the CPT® 2018 code set simplified coding in some ways (multiple procedures in one code), but there are still questions to be answered about how to handle specific scenarios. In case you missed it, the 2018 Correct Coding Initiative (CCI) manual answered some of those questions. Read on to get those details.

Get Guidance Straight From the CCI Manual

When your documentation shows diagnostic bone marrow aspiration, diagnostic bone marrow biopsy, or both, the CCI manual gives the following instructions on how to code.

Diagnostic bone marrow aspiration alone: Report 38220 (Diagnostic bone marrow; aspiration(s)).

  • Note that the 2018 CCI manual adds an (s) on aspiration(s), meaning the code is appropriate for one or more aspirations. This change is in line with the official 2018 CPT® code descriptor above.

Diagnostic bone marrow biopsy alone: Report 38221 (Diagnostic bone marrow; biopsy(ies)).

  • Again, the 2018 CCI manual adds parentheses on the procedure term, this time on biopsy(ies), in line with the official CPT® descriptor above.
  • The CCI manual states you should not report 38221 with superficial bone biopsy code 20220. CCI edits back this up by bundling 20220 into 38221 with a modifier indicator of 1, meaning you may override the edit in circumstances such as separate session or site.

Diagnostic bone marrow aspiration and biopsy, ipsilateral iliac bone: Report 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)).

  • Remember that ipsilateral iliac refers to the same-side hip bone.
  • The CCI manual goes on to state you should not use 38220 in addition to 38221 for aspiration and biopsy on the same bone. You have 38222 for that service now.

Diagnostic bone marrow aspiration(s) at one site or session, diagnostic bone marrow biopsy(ies) at another: Report 38220 (aspiration) and 38221 (biopsy) together.

  • That’s a mouthful, so let’s look at the CCI manual’s exact wording so you can work from the official rule: You may report 38220 and 38221 together only “if the two procedures are performed without accompanying biopsy(ies) or aspiration(s) respectively on different iliac bones or sternum or at separate patient encounters.”
  • A CCI edit bundles 38220 into 38221, so you’ll need a modifier to report the two codes together in those limited cases where it’s appropriate:
    • Aspiration at one site, biopsy at another
    • Aspiration at one encounter, biopsy at another.

You Caught the Restriction to Diagnostic, Right?

The CPT® 2018 code descriptors for 38220-38222 all specify “diagnostic.” Remember to look elsewhere for a code if your surgeon extracts bone marrow for a non-diagnostic purpose. Check for the code intended for that service, such as new code +20939 (Bone marrow aspiration for bone grafting, spine surgery only …).

What About You?

One consequence of the addition of 38222 was the end of G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service). Are you glad Medicare now allows use of the CPT® code instead of HCPCS?



Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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