Oncology & Hematology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: I work for six oncologists, and we do our outpatient bone marrow biopsies at a hospital. I have been told that billing is the hospitals responsibility. Is this correct?

Michigan Subscriber





Answer: If it was performed in the office, bill 85102 (bone marrow biopsy, needle or trocar) and 85095 (bone marrow; aspiration only). To show that the biopsy and aspiration are distinct procedures, modifier -59 (distinct procedural service) is attached to 85095. In addition, bill 85097 (smear interpretation only, with or without differential cell count).

If the aspiration and biopsy are done in the hospital, the codes are nearly identical. Use codes 85102, 85095-59, and 85097. We attach modifier -26 (professional component) to show that the hospital procedure had a physician component.

Insurance companies bundle the bone marrow biopsy and bone marrow aspiration performed on the same day, so use the -59 modifier to show that two distinct services were performed on the same day that are not normally reported together, but are appropriate under the circumstances. We have not had a problem getting reimbursed.

Check with individual payers regarding their policies. Some private insurers consider aspirations and biopsies as bundled services. Medicare recognizes the two as distinct procedures.