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http://kidshealth.org/kid/health_problems/index.html
(38100 – 38999)
Hemic - of or pertaining to blood
Lymphatic System - is an extensive drainage network that helps keep bodily fluid levels in
balance and defends the body against infections. The lymphatic system also helps defend the
body against germs like viruses, bacteria, and fungi that can cause illnesses.
Subsection are divided into subheadings:
 Spleen - is located in the upper left part of the abdomen under the ribcage, works as part
of the lymphatic system to protect the body, clearing worn out red blood cells and other
foreign bodies from the bloodstream to help fight off infection
 Located in CPT book under the main terms
 Lymph Nodes/Lymphatic Channels - located in CPT book under the main terms
Further divided based on type of procedure
Ex. Procedure Performed – Splenectomy, performed laparascopically. Patient had a splenic
hematoma following trauma in a football game. He was kicked. OOp report on pg 226 SBS
WB)
Look under Splenectomy, Laparoscopic, pg 743 CPT- 38120, pg 203
Pg. 518 - SBS
Medical Term: Bone marrow is a thick, spongy kind of jelly inside your bones. Bone marrow
makes all kinds of blood cells: red blood cells that carry oxygen, white blood cells that fight
infections, and platelets that help blood clot
Bone Marrow Aspiration – 38220
Aspiration – needle is inserted into the marrow cavity. Then marrow is then pulled
through the needle and into the syringe.
Bone Marrow Biopsy – 38221
Samples are obtained by a needle or a trocar
Ex. 38821 - Bone marrow biopsy by needle aspiration
Pg. 607 – Biopsy, Bone Marrow
Pg. 203
Pg. 518 SBS
Note: Insurances may or may not pay for both an aspiration and a biopsy so check policy in the
state you are residing. Also, Medicare does not pay for both. Check Medicare policy to see if a
“G” code is billed with 38221 also.
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Bone Marrow Harvesting – 38320
What is a bone marrow transplantation? – pg. 519
Bone marrow transplantation (BMT) is a special therapy for patients with cancer or other
diseases which affect the bone marrow. A bone marrow transplant involves taking cells that are
normally found in the bone marrow (stem cells), filtering those cells, and giving them back either
to the patient or to another person. The goal of BMT is to transfuse healthy bone marrow cells
into a person after their own unhealthy bone marrow has been eliminated.
Transplantation – 38240 – 38242. The preparation and harvesting of those cells falls under
38207 – 38215.
Types of Bone Marrow:
 Allogenic – bone marrow from the same species. Donor testing takes place to make
sure there is as close a match as possible
 Autologous – bone marrow comes from the same patient, processed, cleaned up and
then put back into the patient
 Stem cell harvesting (38205 – 38206) collection of stem cells from the blood system
through a process called apheresis. The blood is removed from the donor in one arm,
filtered, and put back into the patient via the other arm.
http://www.umm.edu/blood/bonemarr.htm
What are the different types of bone marrow transplants?
There are different types of bone marrow transplants depending on who the donor is. The
different types of bone marrow transplant include the following:
 autologous bone marrow transplant
The donor is the patient him/herself. Stem cells are taken from the patient either by bone
marrow harvest or apheresis (peripheral blood stem cells) and then given back to the
patient after intensive treatment. Often the term "rescue" is used instead of "transplant."
 allogeneic bone marrow transplant
The donor shares the same genetic type as the patient. Stem cells are taken either by
bone marrow harvest or apheresis (peripheral blood stem cells) from a geneticallymatched donor, usually a brother or sister. Other donors for allogeneic bone marrow
transplants include the following:
 a parent - a haploid-identical match is when the donor is a parent and the genetic match
is at least half identical to the recipient.
 an identical twin - a syngeneic transplant is an allogeneic transplant from an identical
twin. Identical twins are considered a complete genetic match for a marrow transplant.
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 unrelated bone marrow transplants (UBMT or MUD for matched unrelated donor) the genetically matched marrow or stem cells are from an unrelated donor. Unrelated
donors are found through the national bone marrow registries.
 umbilical cord blood transplant
Stem cells are taken from an umbilical cord immediately after delivery of an infant.
These stem cells reproduce into mature, functioning blood cells quicker and more
effectively than do stem cells taken from the bone marrow of another child or adult. The
stem cells are tested, typed, counted, and frozen until they are ready to be transplanted.
Pg, 519-520 – SBS
Take regions of neck lymph nodes from pg 520 and put on page 203 of CPT Bk if you can
Lymph Nodes – divided on the basis of various procedures. The majority are under Excision
codes (38500 – 38555) for biopsy or excision and then based on the method and then the
location. If opening up the patient, use procedure codes (38510 – 38530).
Limited Lymphadenectomy – 38562 – 38564
Radical Lymphadenectomy – 38700 – 38780
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Staging – pg 520 SBS
http://cancerguide.org/basic.html
TNM Staging
In the TNM system, TNM stands for Tumor, Nodes, and Metastases. Each of these is
categorized separately and classified with a number to give the total stage.
T: Tumor - T Classifies the extent of the primary tumor, and is normally given as T0 through T4.
T0 represents a tumor that has not even started to invade the local tissues. This is called "In
Situ". T4 on the other hand represents a large primary tumor that has probably invaded other
organs by direct extension, and which is usually inoperable.
N: Lymph Nodes - N classifies the amount of regional lymph node involvement. It is important
to understand that only the lymph nodes draining the area of the primary tumor are considered
in this classification. Involvement of distant lymph nodes is considered to be metastatic disease.
The definition of just which lymph nodes are regional depends on the type of cancer. N0 means
no lymph node involvement while N4 means extensive involvement. In general more extensive
involvement means some combination of more nodes involved, greater enlargement of the
involved nodes, and more distant (But still regional) node involvement.
M: Metastasis
M is either M0 if there are no metastases or M1 if there are metastases.
As with the other system, the exact definitions for T and N are different for each different kind of
cancer.
For example, stage II non-small cell lung cancer means a T1 or T2 primary tumor with N1 lymph
node involvement, and no metastases (M0).
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Mediastinum 39000 – 39499 (pg 522-523 SBS TB)
Note: Divided by procedures
Can find in the index under Mediastinum
 Incision 39000 – 39010
o Watch the approach used
 Cervical (neck area)
 Across the thoracic area (transthoracic)
 Sternum
 Excision 39200 – 39220
o Based on whether a cyst or tumor was excised
 Mediastinotomy – done for purposes of exploration, drainage, removal of
a FB or biopsy
Ex. Exploratory mediastinotomy with biopsy of mediastinal lesion accomplished with approach
thru the neck. Pathology report later indicated primary, malignant neoplasm.
Look under Mediastium, then exploration – 39000-39010 – pg 693 CPT
39000 – pg 205
Diaphragm 39501 – 39599 – pg. 523 SBS
Diaphragm – wall of muscle that separates the thoracic and abdominal cavities
Ex. Ever get the hiccups? Don't worry – it's just your diaphragm doing something different! This
thin, dome-shaped muscle helps you breathe and separates the lungs from your stomach and
intestines. When it gets irritated, the diaphragm forces the air out of your lungs in a funny way.
Hic! (http://kidshealth.org/kid/word/d/word_diaphragm.html)
Ex. Connie was brought to the operating room for a sliding hiatal hernia, and transthoracic
repair was performed.
A. 39520, 553.3
B. 39503, 756.6 (not a neonate)
C. 39530, 553.3 (nothing combined)
D. 39540, 756.6 (not a neonate)
39520 – Repair, diaphragmatic hernia (esophageal hiatal); transthoracic
39503 – Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or
without creation of ventral hernia
39530 – Repair, diaphragmatic hernia (esophageal hiatal); combined, thoracoabdominal
39540 – Repair, diaphragmatic hernia (other than neonatal), traumatic; acute
 Repair 39501 – 39561
 Other Procedures 39599
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