You Be the Coder:
Bone Marrow Biopsy and Aspiration
Published on Mon Apr 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Medicare denied our first claim using the new bone marrow codes. We billed 99211 (Office or other outpatient visit), 38221 and 38220 with modifier -51 (Multiple procedures) attached. The office visit was denied and the carrier said no E/M codes are allowed on the same day as surgery. Code 38220-51 was denied and the carrier said 38220 should be bundled with 38221. Can these three codes be billed separately?
Washington Subscriber
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Answer: Codes 38220 (Bone marrow aspiration) and 38221 (Bone marrow biopsy, needle or trocar) were introduced in 2002. Former aspiration code 85095 and former biopsy code 85102 were deleted.
These new codes are now included in the Correct Coding Initiative (CCI) version 8.0, effective Jan. 1, 2002, as a comprehensive/component code pair. A comprehensive/component code pair means that Medicare will pay for only the comprehensive code; the component code is considered an incidental service. The CCI indicates that comprehensive code 38221 now includes component code 38220, so Medicare will only pay for 38221. Many commercial payers are following these guidelines as well.
It is important to note that these are now categorized as "surgery" codes and therefore fall under surgical guidelines. If a significant, separately identifiable E/M service is provided on the same day as the bone marrow procedure, attach modifier -25 to the E/M service code. If the E/M service is related to the bone marrow procedure, it is unlikely to be paid and should not be billed.
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