Pathology/Lab Coding Alert

Pay heed to new CCI instruction, too.

When you report your pathologist's bone marrow cases in 2018, you need to notice some code and coverage changes that may alter how you file your claims.

Here's why: You have one new and one revised CPT^® code, plus one deleted HCPCS Level II code that changes how you report bone marrow extraction services as of Jan. 1.

That's not all: Medicare's 2018 NCCI Policy Manual also provides some new instruction that could impact how you code bone marrow cases moving forward.

Check Out These Code Changes

CPT^® 2018 adds new code 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)).

You'll also find that CPT^® revises the following two codes, adding the modifier "diagnostic" to the code definition, and adding (s) to emphasize that the code describes all specimen extraction in a single surgical session:

• 38220 (Diagnostic bone marrow; aspiration(s)). (2017 definition: Bone marrow, aspiration only)
• 38221 (Diagnostic bone marrow; biopsy(ies)). (2017 definition: Bone marrow, biopsy, needle or trocar).

More change: HCPCS Level II deletes G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) effective Dec. 31, 2017.

Watch for Coding Trouble From Same Site Extraction

Pathologists may sometimes perform a bone marrow aspiration and biopsy from the same site. "The bone marrow biopsy and aspiration specimens can provide different diagnostic information for certain leukemia evaluations, so taking both specimens from the same patient on the same day isn't unusual," says R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.

But if the bone marrow biopsy and aspiration are from the same site during the same surgical session, Medicare and many other payers won't pay for both 38220 and 38221.

Old way: To solve this problem, "for Medicare patients you would report 38221 and G0364, says Kelly Loya, CPhT, CPC-I, CHC, CRMA, Managing Director of Pinnacle Enterprise Risk Consulting Services. Other payers may have required different coding.

Different sites: If you have documentation that the two procedures occur at different anatomic sites or at different surgical sessions, you may separately bill the biopsy and aspiration as 38221, plus 38220 with modifier 59 (Distinct procedural service), or other appropriate modifier.

Describe Both Procedures with One New Code

With the 2018 deletion of G0364 and addition of 38222, you need to adjust the way you report bone marrow biopsy and aspiration through the same incision.

New way: For a bone marrow biopsy and aspiration from the same site during the same surgical session, you'll now need to report the service using just one code: 38222. That's true for Medicare or any other payers, which should simplify your coding for these cases.

Don't miss: Instead of billing the biopsy as 38221 and adding a separate code (G0364) for the aspiration through the same incision, you'll now report a single code that describes both the biopsy and the aspiration (38222).

Exception: You can still report 38221 and 38220-59 for distinct bone marrow biopsy and aspiration procedures at different sites. According to the Correct Coding Initiative (CCI) 2018 NCCI Policy Manual, "The bone marrow aspiration(s) procedure (CPT^® code 38220) shall not be reported separately with the bone marrow biopsy(ies) procedure (CPT^® code 38221) unless the two procedures are performed on different bones or at separate patient encounters on the same date of service."

See the Cost Impact

Based on the 2018 Medicare Physician Fee Schedule, you can expect to lose a little pay when your surgeon performs aspiration and biopsy through the same incision.

In 2018, you'll get paid $174.24 for 38222 (national non-facility amount, conversion factor 35.9996). That's the same fee you can expect for an aspiration alone (38220), and less than the fee for a biopsy alone (38221, $156.96 national non-facility amount, conversion factor 35.9996).

Old way: In 2017, if you billed for a bone marrow biopsy and aspiration using 38221 and G0364, you would have been paid $171.19 for 38221, and $12.56 for G0364, for a total fee of $183.75 (national non-facility amount, conversion factor 35.8887). That's a little more than the $174.24 you can expect this year.

Know the Specimen and Purpose When Selecting Codes

"Codes 38220-38222 are not the only CPT^® procedure codes that describe bone marrow extraction," says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, director of operations with Encounter Telehealth in Omaha, Nebr. A similar procedure using a needle or trocar may result in a specimen that contains both bone and bone marrow.

Also notice that the CPT^® 2018 revisions add the word "diagnostic" to the 38220-38222 code descriptors. If the bone marrow extraction is for a non-diagnostic purpose, such as for a bone graft or stem-cell injection, you should turn to other codes, such as one of the following:

• +20939 (Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure))
• 0232T (Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed).

Guide Specimen Exam Coding With These Tips

Bone marrow biopsy and aspiration result in two different specimen types, and the following two codes describe pathology exam of the specimens:

• 88305 (Level IV - Surgical pathology, gross and microscopic examination, ...Bone marrow, biopsy...)
• 85097 (Bone marrow, smear interpretation).

The pathologist might also evaluate a particle clot (cell block) processed from the bone marrow aspiration specimen, and the correct code for that exam is also 88305 (...Cell block, any source...).

Multiple codes ok: If the pathologist examines distinct specimens, such as a bone marrow biopsy specimen and a bone marrow aspirate specimen from a 38222 procedure, you can report both 88305 and 85097 together. You can report an additional unit of 88305 for the exam of a separately-processed cell block.

Bone biopsy is different: If your pathologist examines a bone biopsy specimen, it may include some bone marrow, but you should report the single, appropriate code for the exam, which is 88307 (Level V - Surgical pathology, gross and microscopic examination, ... Bone - biopsy/curettings...). Don't additionally report 88305 or 85097 for any bone marrow included in the specimen.

Note CCI instruction: The 2018 NCCI Policy Manual adds the following paragraph to help clarify your bone coding:

"Bone marrow biopsy(ies) are typically performed with a Jamshidi needle yielding a cylindrical core of bone and marrow. The surgical pathology interpretation of this type of specimen is reported with CPT® code 88305. A bone biopsy is typically performed with a different instrument and yields a larger non-cylindrical bony specimen which may include some bone marrow. The surgical pathology interpretation of this type of specimen may be reported with CPT^® code 88307."