Oncology & Hematology Coding Alert

Question: For private payers, should I report G0364 or 38220 for aspiration and biopsy at the same session?

Illinois Subscriber

Answer: As is so often the case, you should get your payer's preference in writing and follow that instruction for that payer.

In general terms, when the physician performs a bone marrow aspiration and biopsy at the same site during the same session, you should report 38221 (Bone marrow; biopsy, needle or trocar) for the biopsy. For private payers who don't accept G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) for same-site, same-session aspiration, you may be able to report 38220 (Bone marrow; aspiration only).

In contrast, if you're reporting to Medicare (or a payer that shares Medicare's rules), you should report both 38221 and G0364 to indicate performance of the two services through the same incision at the same session.

As Medicare's Correct Coding Initiative manual, chapter V, section E (effective Jan. 1, 2012), explains it:

• When the physician performs bone marrow aspiration alone, the appropriate code is 38220.
• When the physician performs bone marrow biopsy alone, the appropriate code is 38221.
• When the physician performs bone marrow aspiration and biopsy at separate sites or separate patient encounters, you may report 38220 and 38221 together. "Separate sites include bone marrow aspiration and biopsy in different bones or two separate skin incisions over the same bone." (Note: You'll need to append a modifier to 38220 to override the edit.)
• When the physician performs bone marrow aspiration and biopsy at the same site through the same skin incision, you should not report 38220 in addition to 38221. Instead, "G0364 may be reported to describe the bone marrow aspiration performed with bone marrow biopsy."

Resource: You may download the "NCCI Policy Manual for Medicare Services" from www.cms.gov/NationalCorrectCodInitEd/.