07DQ3ZZ
Extraction Bone Marrow, Sternum to No Qualifier with No Device, Percutaneous Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 7 Lymphatic and Hemic Systems |
| Operation | D Extraction |
| Body Part | Q Bone Marrow, Sternum |
| Approach | 3 Percutaneous |
| Device | Z No Device |
| Qualifier | Z No Qualifier |
Operation Definition
Pulling or stripping out or off all or a portion of a body part by the use of force
Procedure Overview
Extraction in this body system almost always refers to bone marrow procedures - pulling out marrow tissue using a needle and manual force rather than a cutting instrument. A physician advances a needle into the marrow cavity, usually at the posterior iliac crest, and withdraws either a liquid marrow sample by aspiration or a solid core sample by twisting and pulling the needle free.
These procedures are performed to evaluate blood cell production when someone has unexplained anemia, abnormal blood counts, a suspected blood cancer, or to stage lymphoma. The same technique, at larger volume, is used to harvest marrow for a stem cell or bone marrow transplant, where the marrow is collected from a donor rather than for diagnosis.
Because the tissue is pulled or stripped out by force rather than sliced away, this family sits apart from ordinary biopsy techniques used on solid organs, even though the clinical intent, sampling tissue for evaluation, is similar.
Anatomy & Axis Detail
Bone Marrow, Sternum
Sternal bone marrow refers to the hematopoietic tissue within the manubrium, a site favored historically for marrow aspiration because the bone lies just beneath the skin and is relatively flat and accessible. Extraction here means drawing marrow cells or a small core of marrow tissue through a specialized needle advanced into the sternal body, used to evaluate suspected leukemia, lymphoma involvement, or other blood disorders when aspirate cellularity from other sites is inadequate. Because the sternum overlies the heart and great vessels, needle depth must be tightly controlled to avoid penetrating the posterior cortex, and this site is used less often today than the iliac crest, largely reserved for cases where iliac sampling is not feasible.
Approach: Percutaneous
Percutaneous describes entry by needle or instrument puncture through the skin or mucous membrane to reach the site of the procedure, without cutting the tissue open or using a visualizing scope. It differs from Open in that the site itself is never exposed, and from Percutaneous Endoscopic in that no endoscope is used to see internal structures. Common examples include needle biopsies and injections.
Coding & Documentation
Coders need documentation specifying whether the procedure was a marrow aspiration (liquid marrow withdrawn by syringe), a core biopsy (a solid cylinder of marrow pulled out with a biopsy needle), or both, since both are captured under Extraction but the approach and diagnostic qualifier may differ. The note should confirm the bone marrow was the target, not a separate skeletal structure, since a bone biopsy with marrow incidentally obtained is coded differently.
A common mistake is defaulting to Excision because the word "biopsy" appears in the note; bone marrow biopsy is Extraction by PCS definition regardless of that word choice. Another error is failing to separately code an aspiration and a core biopsy performed at the same session through two separate needle passes, when guidelines call for capturing both.