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Code This Case With Care: Childhood Cancer


Diagnostic: Bone Marrow and Biopsy


A 7-year-old female patient was awake late at night weeping, complaining of joint discomfort and having a fever. The following morning, the patient's parents brought her to their pediatrician. The patient's belly exhibited some swelling, and she also appeared pale and exhausted. She was a picky eater, but the father did mention to the caregiver that she was now eating less than usual. The pediatrician examined the patient and noted the swollen lymph nodes and abdomen. To determine the patient's white blood cell count, the pediatrician requested a blood smear and complete blood count (CBC) (WBC).


The test findings revealed an elevated WBC count and insufficient levels of red blood cells and platelets. Leukemia is the most likely diagnosis, while hematological diseases such as anemia are also conceivable.


The youngster was referred to our pediatric oncology clinic, where an oncologist conducted an aspiration and biopsy of the patient's bone marrow to make a clinical diagnosis.


Coding:

38222 Diagnostic bone marrow; biopsy(ies) and aspiration(s)

In many cases, an aspiration with a biopsy will give the clearest diagnosis of cancer. CPT® 38222, as well as 38220 Diagnostic bone marrow; aspiration(s) and 38221 Diagnostic bone marrow; biopsy(ies), require a laterality modifier to indicate left, right, or bilateral (LT, RT, or 50), so this information must be documented in the provider’s note.


Typically, the samples are collected from the rear of the pelvic (hip) bones, although they can also come from the front or from other bones. Before the testing, a local anesthetic is injected into the skin above the hip bone or a numbing lotion is used to numb the area. The youngster is typically also given additional medications to make them sleepy or drowsy throughout the testing. Initially, a thin, hollow needle is inserted into the bone, and a little quantity of liquid bone marrow is aspirated using a syringe. This procedure is known as aspiration. The aspiration is often followed immediately by a bone marrow biopsy. With a little bigger tool, a tiny bit of bone and marrow is extracted.


I hope this information is helpful. Be sure to follow me on TikTok @MedicalCodingByJen for Free 2 hour educational Lives Mon, Weds, & Fri at 6:30 pm Arizona time zone! See you then!

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