Pathology/Lab Coding Alert

"Some of the confusion regarding appropriate coding for various bone sampling and evaluation procedures is removed when coders understand the difference between bone-marrow aspiration, bone-marrow biopsy and bone biopsy in terms of indications, procedures and types of specimen procured. Additionally, coders need to be familiar with the different codes for specimen collection, manipulation and evaluation, including the technical and professional components of each. With this understanding, pathologists and laboratories can better capture reimbursement for specimen sampling, preparation and pathologic examination. Practices also need to be aware of appropriate coding for adjunct procedures, such as cell blocks and special stains, so they will be reimbursed appropriately for those services as well.

Bone-marrow Biopsy

R.M. Stainton Jr., MD, president of Doctors Anatomic Pathology Services , an independent pathology laboratory in Jonesboro, Ark., explains that bone-marrow biopsy often is used in the diagnosis of a host of diseases involving the bone marrow. The procedure may be ordered for primary neoplasia [cancers] such as myeloblastic leukemia [205.00] or acquired aplastic anemia [284.98] or metastatic disease with secondary bone-marrow involvement, he continues. Overall, it is an excellent tool for assessing cellularity [condition and degree of cells present] of bone marrow, he claims.

Bone-marrow biopsy is carried out through a small incision made over the biopsy site, typically the superior iliac spine. A needle or trocar is inserted through the cortex of the bone, and a core of marrow is removed. A pathologist or hematologist/oncologist often carries out this procedure. The appropriate CPT Code for the procedure is 85102 (bone marrow biopsy, needle or trocar).

Following the biopsy, typically, laboratory technicians prepare the bone-marrow tissue for examination by a pathologist. The basic slide preparation services for the bone-marrow specimen are considered bundled in the surgical pathology code used to report the service, 88305 (surgical pathology, gross and microscopic examination, bone marrow, biopsy). Preparing the tissue for examination comprises the technical component of the code and for Medicare and many third-party payers should be reported as 88305-TC (technical component) if the laboratory and the pathologist bill separately, advises Laurie Castillo, MA, CPC, president of the Northern Virginia Chapter of the American Academy of Professional Coders, and owner of Physician Coding & Compliance Consulting in Manassas, Va. You should check with the insurer involved, however, to determine if -TC is the appropriate modifier, she cautions.

In addition to the usual steps of specimen preparation, bone-marrow biopsy specimens typically require a separate step to remove calcium that is not considered a bundled service, Stainton informs. It is reported separately using CPT 88311 (decalcification procedure). This is an add-on code, meaning [...]