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 purpose

A fictional adult undergoes diagnostic bone marrow sampling. The order and procedure report identify the right iliac bone. The clinician performs both aspiration and biopsy during one encounter and records the work separately.

Procedure record

The aspiration and biopsy are obtained from the same right iliac bone. The record does not describe sampling from the opposite iliac bone, the sternum or another encounter. Both actions are completed as documented.

Specimen record

The laboratory receives aspirated material and a biopsy specimen in separate containers. This preserves the different types of material for analysis but does not establish different anatomical sites.

Coding request

A draft automatically reports an aspiration entry and a separate biopsy entry because two sampling methods occurred. The learner must investigate the combined service for the ipsilateral iliac relationship before choosing the final code. This case does not generalize that combination to every bone or encounter.

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