38220

Diagnostic bone marrow aspiration

Bone marrow aspiration is a vital diagnostic procedure used to obtain a sample of the liquid portion of the bone marrow for microscopic examination and laboratory analysis. This procedure is fundamental in the field of hematology and oncology for the evaluation of a wide range of hematologic disorders, including malignancies, anemias, and infectious diseases. The process typically involves a specialized needle with a removable stylet. The clinician identifies the optimal site for the procedure, which is most commonly the posterior superior iliac crest due to its accessibility and safety. Other potential sites include the anterior iliac crest or, in adults only, the sternum. After the site is prepared using sterile technique, a local anesthetic is injected into the skin and down to the periosteum of the bone to minimize patient discomfort. The aspiration needle is then advanced through the cortical bone until it reaches the medullary cavity. Upon entering the cavity, the stylet is removed, and a syringe is attached to the needle hub. The clinician quickly pulls back on the plunger to create negative pressure, drawing a small volume of marrow fluid (usually 1 to 2 milliliters) into the syringe. This fluid contains marrow spicules, which are crucial for assessing the cellularity and morphology of the marrow. The sample is then immediately used to create slides for staining or placed in specific media for advanced tests like flow cytometry, cytogenetics, or molecular studies. It is important to note that CPT 38220 represents only the aspiration component. If a core biopsy is performed through the same or a different incision at the same session, different coding rules apply to prevent bundling errors.

Clinical Indications

  • Unexplained anemia, leukopenia, or thrombocytopenia
  • Evaluation of pancytopenia
  • Diagnosis and staging of acute and chronic leukemias
  • Staging of lymphomas and multiple myeloma
  • Investigation of metastatic solid tumors to the bone marrow
  • Evaluation of myelodysplastic syndromes (MDS)
  • Diagnosis of storage diseases (e.g., Gaucher disease)
  • Evaluation of fever of unknown origin for marrow-based infections
  • Monitoring response to chemotherapy or bone marrow transplantation

Procedure Steps

  1. Position the patient (usually in a prone or lateral decubitus position for iliac crest access).
  2. Identify and mark the aspiration site (typically the posterior superior iliac spine).
  3. Cleanse the area with an antiseptic solution and apply sterile drapes.
  4. Administer local anesthesia to the skin, subcutaneous tissue, and the periosteum.
  5. Make a small skin incision with a scalpel or directly introduce the aspiration needle.
  6. Insert the marrow aspiration needle with the stylet in place through the bone cortex.
  7. Remove the stylet once the needle is securely within the marrow cavity.
  8. Attach a syringe and aspirate 1-2 mL of marrow fluid.
  9. Remove the needle and apply firm pressure to the site to achieve hemostasis.
  10. Prepare marrow smears on glass slides or transfer the specimen to appropriate transport tubes.
  11. Apply a sterile dressing to the puncture site.

Coding Guidelines

  • CPT 38220 is used for a diagnostic bone marrow aspiration.
  • Do not report 38220 in conjunction with 38221 (bone marrow biopsy) for the same site. If both aspiration and biopsy are performed at the same site, use CPT 38222.
  • If bone marrow aspiration (38220) and biopsy (38221) are performed at different sites or separate encounters on the same date, 38220 may be reported with modifier 59.
  • Local anesthesia is considered an inherent part of the procedure and is not separately billable.
  • Imaging guidance (e.g., fluoroscopy 77002, ultrasound 76942, or CT 77012) may be reported separately if utilized and documentation supports its use.
  • For marrow aspiration performed for the purpose of transplantation rather than diagnosis, see CPT codes 38230-38232.

Associated ICD-10 Codes