CPT® Code 38222

Diagnostic bone marrow biopsy and aspiration, represented by CPT® Code 38222, is a medical procedure utilized to obtain samples from the bone marrow for the purpose of diagnosing various hematological diseases and cancers. This procedure involves the extraction of both liquid and solid samples from the bone marrow, which is a crucial component of the body's hematopoietic system. The most common sites for obtaining these samples are the anterior or posterior iliac crest, which are the prominent bones located in the pelvis. In certain cases, such as aspiration only, samples may also be taken from the breastbone or, particularly in pediatric patients under 18 months, from the lower leg. During the procedure, if both a biopsy and aspiration are performed, the aspiration is typically conducted first. The process begins with the creation of a small incision in the skin over the iliac crest, followed by the insertion of a hollow needle attached to a syringe. The needle is carefully advanced to a depth of approximately 4-5 cm, ensuring that surrounding nerves, such as the lateral femoral cutaneous nerve and the cluneal nerves, are avoided. The technique involves applying firm pressure while using a combination of clockwise and counterclockwise motions or gentle taps with a mallet to facilitate the advancement of the needle. Once the needle is properly positioned, the plunger is pulled back to aspirate a sample of liquid bone marrow. If the initial attempt does not yield a sample, the needle may be repositioned to obtain additional aspirate. For the biopsy component, a larger needle is employed to extract a cylindrical core sample of solid bone marrow tissue. This can be done either through the same incision used for aspiration or via a new entry point. After the biopsy is completed, the incision site is appropriately bandaged to promote healing. This comprehensive approach allows for a thorough evaluation of the bone marrow, aiding in the diagnosis of various conditions affecting blood cell production and function.