Two marrow samples from one iliac bone

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Medicare respiratory or cardiovascular professional service

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Diagnostic indication

Synthetic outpatient procedure record, September 9, 2026. An adult with persistent unexplained pancytopenia is referred for diagnostic marrow examination. The clinician plans aspiration and a core marrow biopsy from the right posterior iliac bone; this is not collection for transplantation.

Signed sampling note

After local anesthesia, the clinician obtains marrow aspirate and a core marrow biopsy from that same right iliac bone during one encounter. Both samples are adequate for submission. No opposite iliac bone, sternum or other site is sampled.

Completion record

Aspirated material and the marrow core are labeled separately for laboratory processing. Pressure and a dressing are applied, with hemostasis documented. The diagnostic results are pending; the completed sampling does not itself establish the cause of the cytopenias.

Procedure worksheet

A draft lists separate aspiration and marrow-biopsy procedure lines because two sampling methods and containers are recorded. Investigate the combined service for the same iliac bone under Medicare NCCI. Keep procedure reporting separate from the laboratory’s own services.

Your coding worksheet

Identify both completed sampling methods.
Record the bone, side and encounter relationship.
Investigate the combined current entry.
Explain why two containers do not require two procedure lines.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

Both diagnostic aspiration and biopsy occurred.
They concern the same right iliac bone during one encounter.
NCCI directs review of the combined service for this specific relationship.
Specimen handling does not override the combined procedure structure. Different sites or encounters would require their own complete review.

Reference sections: E.1

Practice the linked chart questions