General Surgery Coding Alert

Learn new way to report aspiration and biopsy together.

When your surgeon extracts a bone marrow biopsy and a bone marrow aspiration specimen from the same patient on the same day, you need to rethink how you code the services in 2018.

That's because you have one new and one revised CPT^® code, plus one deleted HCPCS Level II code that changes how you report bone marrow extraction services as of Jan. 1. Not only that, but with the code changes, you should no longer need to report these services differently for different payers.

Check Out These Code Changes

CPT^® 2018 adds new code 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)).

You'll also find that CPT^® revises the following two codes, adding the modifier "diagnostic" to the code definition, and adding (s) to emphasize that the code describes all specimen extraction in a single surgical session:

• 38220 (Diagnostic bone marrow; aspiration(s)). (2017 definition: Bone marrow, aspiration only)
• 38221 (Diagnostic bone marrow; biopsy(ies)). (2017 definition: Bone marrow, biopsy, needle or trocar).

More change: HCPCS Level II deletes G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) effective Dec. 31, 2017.

Same Site Means Coding Trouble

Surgeons may sometimes perform a bone marrow aspiration and biopsy from the same site. "The bone marrow biopsy and aspiration specimens can provide different diagnostic information for certain leukemia evaluations, so taking both specimens from the same patient on the same day isn't unusual," says R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.

But if the surgeon extracts a bone marrow biopsy and aspiration from the same site during the same surgical session, Medicare and many other payers won't pay for both 38220 and 38221.

Old way: To solve this problem, you should have been using G0364 in addition to 38221 when your surgeon extracted a bone marrow biopsy and aspiration through the same incision on the same day for Medicare beneficiaries. Other payers may have required different coding.

Different sites: If you have documentation that the surgeon performed the two procedures at different anatomic sites or at different surgical sessions, you may bill separately bill the biopsy and aspiration as 38221, plus 38220 with modifier 59 (Distinct procedural service), or other appropriate modifier.

Describe Both Procedures With One New Code

With the 2018 deletion of G0364 and addition of 38222, you need to adjust the way you report bone marrow biopsy and aspiration through the same incision.

New way: If the surgeon extracts a bone marrow biopsy and aspiration from the same site during the same surgical session, you'll now need to report the service using just one code: 38222. That's true for Medicare or any other payers, which should simplify your coding for these cases.

Don't miss: Instead of billing the biopsy as 38221 and adding a separate code (G0364) for the aspiration through the same incision, you'll now report a single code that describes both the biopsy and the aspiration (38222).

Exception: You can still report 38221 and 38220-59 if your surgeon performs distinct bone marrow biopsy and aspiration procedures at different sites. According to the Correct Coding Initiative 2018 NCCI Policy Manual, "The bone marrow aspiration(s) procedure (CPT^® code 38220) shall not be reported separately with the bone marrow biopsy(ies) procedure (CPT^® code 38221) unless the two procedures are performed on different bones or at separate patient encounters on the same date of service."

See the Cost Impact

Based on the 2018 Medicare Physician Fee Schedule, you can expect to lose a little pay when your surgeon performs aspiration and biopsy through the same incision.

In 2018, you'll get paid $174.24 for 38222 (National Non-Facility amount, conversion factor 35.9996). That's the same fee you can expect for an aspiration alone (38220), and less than the fee for a biopsy alone (38221, $156.96 National Non-Facility amount, conversion factor 35.9996).

Old way: In 2017, if you billed for a bone marrow biopsy and aspiration using 38221 and G0364, you would have been paid $171.19 for 38221, and $12.56 for G0364, for a total fee of $183.75 (National Non-Facility amount, conversion factor 35.8887). That's a little more than the $174.24 you can expect this year.

Beware Similar Extraction Codes

"Codes 38220-38222 are not the only CPT^® procedure codes that describe bone marrow extraction, so you need to be familiar with the other options to ensure that you're always reporting the most specific code," says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, director of operations with Encounter Telehealth in Omaha, Nebr.

For instance: If the surgeon performs a bone biopsy using a needle or trocar, the procedure is similar and the specimen will contain bone marrow, but you should select a more specific code such as one of the following:

• 20220 (Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs))
• 20225 (... deep (eg, vertebral body, femur))

Diagnostic: Also notice that the CPT^® 2018 revisions add the word "diagnostic" to the 38220-38222 code descriptors. If your surgeon extracts bone marrow for a non-diagnostic purpose, such as for a bone graft or stem-cell injection, you should turn to other codes, such as one of the following:

• +20939 (Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure))
• 0232T (Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed).