CPT Questions

April 2003

Q: Which frozen section codes, 88331 and/or 88332, do I report if the first specimen required one frozen section to confirm the adequacy of the surgical margins and the second specimen required frozen sections on two tissue blocks?

A. Use code 88331, Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen, for the first frozen section on the two specimens submitted separately. Use code 88332, Pathology consultation during surgery; each additional tissue block with frozen section(s), for the additional frozen section on the second specimen.

Based on the information provided, report two units of 88331 and one unit of 88332.

Q: The word “only” has been added to code 38220 so that it now reads, Bone marrow; aspiration only. Code 38221, Bone marrow; biopsy, needle or trocar, has been indented beneath it. Do these changes affect the way I should use the codes?

A. In CPT 2003, changes were made to the therapeutic apheresis and bone marrow transplantation codes to reflect current clinical practices and to create greater granularity to accurately describe the elements of a procedure. Although the bone marrow codes were changed as part of this effort, the intent of the revisions was not to change the established use of these codes. The changes were made to better differentiate the bone marrow biopsy codes from the bone marrow harvest procedure codes. The word "only" was added not to prevent users from billing 38220 with biopsy code 38221 when both procedures were performed but to differentiate the codes from the bone marrow harvest procedures. The American Medical Association’s CPT Changes 2003—An Insider’s View (page 101) explains the intent of the revision. For non-Medicare patients, continue to report both codes when both procedures are performed.

Codes 38220 and 38221 are part of the Correct Coding Initiative edits for the Medicare program. If both codes are submitted on the same day for the same patient, the CCI edit program will deny the aspiration procedure unless a modifier is used appropriately. When a physician performs a bone marrow biopsy and aspiration through the same incision/ puncture during the same patient encounter, only code 38221 should be reported according to the Centers for Medicare and Medicaid Services. Using the -59 modifier with code 38220 to bypass the CCI edit is only appropriate if the biopsy and aspiration were performed on distinctly different anatomic sites or if the two procedures were performed during different patient encounters on the same date of service.

Frequently asked questions about CPT are published bimonthly in “Capitol Scan.” This section of CAP TODAY is a product of the CAP Economic Affairs Committee.

The codes and descriptions listed here are from Current Procedural Terminology, 4th ed., CPT 2006. CPT 2006 is copyrighted by the American Medical Association. To purchase CPT books, call the AMA at 800-621-8335.

For more information about CPT coding, visit the CPT Coding Resource Center on the CAP Web site.