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Oncology & Hematology Coding Alert

Reader Questions:

Biopsy/Aspirations May Need G Code for Medicare

Published on Sat Jan 22, 2005

Question: I have heard that there is a new G code for use with some bone marrow biopsies and aspirations. Is this true, and if so, how do we use the new G code when reporting to Medicare?

Mississippi Subscriber
 
Answer: There is a new code Medicare wants you to use, but only if the oncologist takes a bone marrow biopsy and aspiration from the same site during the same session.
 
When your oncologist performs a bone marrow biopsy and aspiration on the same site in the same session for a Medicare patient, you should:
 

  • report 38221 (Bone marrow; biopsy, needle or trocar) for the procedure.
     
  • attach G code G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) to 38221. You do not need to use G0364 for insurers other than Medicare.

    Remember: This does not affect how you report other bone marrow biopsy situations, which you should continue to report without G codes in 2005.

    If, for example, there is a bone marrow aspiration only, you should report 38220 (Bone marrow; aspiration only).
     
    If the oncologist only takes a bone marrow biopsy, report 38221.
     
    If there is a bone marrow biopsy from one anatomic site or during one session, and a bone marrow aspiration from another site or during another session, you should:
     

  • report 38221 for the biopsy.
     
  • report 38220 for the aspiration.
     
  • attach modifier -59 (Distinct procedural service) to 38220 to show that the aspiration was a separate procedure from the biopsy.

     Current estimates indicate that proper use of this G code will add about $9.85 to your claim.

     - Clinical and coding expertise for this issue of Oncology Coding Alert provided by Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies  Inc. in Dallas, Ga.

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