Oncology & Hematology Coding Alert

Question: I'm confused about proper use of G0364. Should we report it by itself to represent aspiration and biopsy, or should we report it with another code?

Answer: For Medicare and payers following Medicare's rule, you should report G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) in addition to 38221 (Bone marrow; biopsy, needle or trocar) when the physician performs bone marrow aspiration (G0364) and biopsy (38221) through the same skin incision on the same date of service.

You can get a better understanding of the rule by reading Correct Coding Initiative (CCI) manual, version 16.3, chapter 5, section E.1. It instructs:

"When both a bone marrow biopsy (CPT code 38221) and bone marrow aspiration (CPT code 38220 [Bone marrow; aspiration only]) are performed at the same site through the same skin incision, do not report the bone marrow aspiration, CPT code 38220, in addition to the bone marrow biopsy (CPT code 38221). HCPCS/CPT code G0364 may be reported to describe the bone marrow aspiration performed with bone marrow biopsy through the same skin incision on the same date of service."

You can access the manual online at www.cms.gov/NationalCorrectCodInitEd/.

Caution: Coding edits allow you to bill 38220 with 38221 with a modifier to override the edit. But you should report the two together only "if the two procedures are performed at separate sites or at separate patient encounters. Separate sites include bone marrow aspiration and biopsy in different bones or two separate skin incisions over the same bone," according to the manual.