Oncology & Hematology Coding Alert

Question: Our oncologist wants to report 85097 when he takes a bone biopsy, looks at the sample, prepares a brief report, and then sends the sample to pathology. In this situation, should I report 85097 for the oncologist's services?

Oklahoma Subscriber

Answer: No. If both the oncologist and the lab report the same code for the same service, the payer will pay only one. In the case you describe, the lab that provides the formal evaluation and report should submit the lab service code. Because the oncologist performed the "bone biopsy," as you describe it, the oncologist should submit a claim for that service.

Service check: Verify the precise service your oncologist performed before submitting your claim: bone marrow aspiration, bone marrow biopsy, or bone biopsy. Your question refers to 85097 (Bone marrow, smear interpretation), which is the lab code for pathology exam of a bone marrow aspiration -- not biopsy. If the oncologist performs a bone marrow aspiration, you should report 38220 (Bone marrow; aspiration only).

If the oncologist instead performs a bone marrow biopsy, you should report 38221 (... biopsy, needle, or trocar). The lab likely will report 88305 (Level IV -- Surgical pathology, gross and microscopic examination, bone marrow, biopsy) for the biopsy evaluation.

For a biopsy of the actual bone, review the bone biopsy codes from 20220-20251 (Biopsy ...), and choose the most accurate code. The lab's code for the bone biopsy examination is 88307 (Level V -- Surgical pathology, gross and microscopic examination, bone -- biopsy/curettings).

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Kelly C. Loya, CPC-I, CPhT, senior consultant with Los Angeles-based Sinaiko Healthcare Consulting Inc.