38221

Bone marrow biopsy, needle or trocar

CPT code 38221 describes the diagnostic procedure of obtaining a core biopsy sample of bone marrow using a needle or trocar for histologic examination. This procedure typically involves the insertion of a specialized biopsy needle, commonly into the posterior iliac crest, to extract a cylindrical tissue sample. It is performed to assess the cellularity, morphology, and architecture of the bone marrow and to detect various hematologic and oncologic conditions. This code specifically represents the procurement of the biopsy component and is distinct from bone marrow aspiration (38220), though often performed concomitantly.

Clinical Indications

  • Diagnosis and staging of hematologic malignancies (e.g., leukemias, lymphomas, multiple myeloma)
  • Investigation of unexplained cytopenias (anemia, leukopenia, thrombocytopenia) or pancytopenia
  • Evaluation of myelodysplastic syndromes or myeloproliferative neoplasms
  • Diagnosis of metabolic storage diseases, granulomatous diseases, or infections involving the bone marrow
  • Assessment for metastasis of solid tumors to the bone marrow
  • Evaluation of fever of unknown origin when bone marrow involvement is suspected
  • Monitoring treatment response or disease progression in certain hematologic conditions

Procedure Steps

  1. Obtain informed consent from the patient and ensure proper patient identification.
  2. Position the patient (typically prone or lateral decubitus for posterior iliac crest) and prepare the skin with an antiseptic solution.
  3. Administer local anesthetic (e.g., lidocaine) to the skin, subcutaneous tissue, and periosteum at the chosen biopsy site.
  4. A small skin incision may be made to facilitate the passage of the biopsy needle.
  5. Advance a specialized bone marrow biopsy needle (e.g., Jamshidi needle) through the skin, subcutaneous tissue, and outer cortex of the bone into the medullary cavity.
  6. Rotate the needle to cut and secure a core sample of bone marrow tissue, ensuring adequate length and quality.
  7. Withdraw the biopsy needle with the core sample intact.
  8. Extrude the biopsy core from the needle and place it in an appropriate fixative (e.g., formalin) for subsequent pathologic examination.
  9. Apply pressure to the biopsy site to achieve hemostasis, then apply a sterile dressing.

Coding Guidelines

  • When both a bone marrow aspiration (38220) and a bone marrow biopsy (38221) are performed at the same site on the same day, both codes may be reported. A modifier (e.g., 59) may be required on 38220 by some payers to bypass National Correct Coding Initiative (NCCI) edits, indicating a distinct procedural service.
  • CPT code 38221 describes the procurement of the specimen; the interpretation of the bone marrow biopsy by a pathologist is reported separately (e.g., CPT code 88305 for surgical pathology or specific hematopathology codes if applicable).
  • Imaging guidance (e.g., fluoroscopic, CT, or ultrasound) used to assist with the bone marrow biopsy is reported separately with appropriate guidance codes (e.g., 77002, 77012, 76942).
  • If separate biopsies are performed on both the right and left iliac crests (bilateral), modifier 50 (Bilateral Procedure) or reporting two units of 38221 with modifiers RT/LT may be applicable, depending on payer-specific policies.
  • Medical record documentation must clearly support the medical necessity for the biopsy and detail the procedure performed, including the site, technique, any complications, and how the specimen was handled.

Associated ICD-10 Codes