Oncology & Hematology Coding Alert

Check Your Payer's Requirements

When the physician performs the biopsy and aspiration on two different bone marrow sites, you may use modifier -59 (Distinct procedural service) to get paid, depending on the number of incisions.

Some Medicare carriers require the physician to make two incisions, while others pay for one incision. Take note: All insurers require separate bone marrow sites.

"We receive rejections when we bill both" 38220 and 38221, says Debbie Ambrose, a billing manager for oncologists at Spectrum Health in Grand Rapids, Mich. Her state's insurers bundle 38220 and 38221 when the oncologist performs a biopsy and aspiration using one incision -- even if he accesses different bone marrow sites, she says.

"You should report the codes separately when the physician accesses two separate sites and makes two different incisions -- that's how I interpret Medicare guidelines," Ambrose says.

The bottom line: If you can report only one code, choose 38221 instead of 38220, because 38221 pays more, Ambrose adds. Nationally, Medicare pays $220 for 38221, and $200 for 38220.

How to Report 1 or 2 Incisions

What to do: If your payer allows one incision but two sites, use the following example as a guide for reporting the codes separately.

The oncologist provides a bone marrow biopsy and aspiration to a leukemia patient (205.x, Myeloid leukemia). Although the physician uses the same incision, he obtains a biopsy of the iliac crest and punctures the sternum for the aspiration.

Because the physician accessed two sites, you may be able to report both 38220 and 38221 to your carrier, as long as you append modifier -59 to one of the codes.

But when the carrier requires two incisions, you should still use modifier -59, which lets the payer know the oncologist performed two distinct services.

To support using the modifier, be sure the physician documents the two incisions.

Lesson learned: You can report 38220 and 38221 together only when the physician performs the biopsy (38221) and aspiration (38220) at separate sites or at separate patient encounters. When the physician administers both a biopsy and bone marrow aspiration at the same site through the same incision, you should assign biopsy code 38221, says Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga.