Pathology/Lab Coding Alert

If your pathologist procures both a bone marrow biopsy and a bone marrow aspiration, how -- or whether -- you'll get paid depends on two guidelines you can read about here.

Because a bone marrow biopsy and a bone marrow aspiration can provide different diagnostic information for certain leukemia evaluations, taking both specimens from the same patient on the same day isn't unusual, according to R.M. Stainton Jr., MD, president of Doctor's Anatomic Pathology, an independent pathology laboratory in Jonesboro, Ark.

Medicare and many other payers restrict how you bill for "sequenced" surgical procedures through the sameincision. That's why CMS has a Correct Coding Initiative (CCI) edit that bundles the following codes:

• 38220 (Bone marrow; aspiration only)

• 38221 (... biopsy, needle or trocar).

But the CCI Policy Manual states that you can report 38220 and 38221 together if the physician performs the procedures at different patient encounters, or "in different bones or two separate skin incisions over the same bone."

Here's how: If the procedures meet one of these criteria, you can override the CCI edit by appending modifier 59 (Distinct procedural service) to 38220 and get paid for both services, Stainton says.

Beware: In one study, the Office of Inspector General (OIG) found that coders inappropriately used modifier 59 more often with 38220/38221 than any other code pair. Don't use 59 just because the two codes represent different procedures/surgeries -- they usually do, CMS says. You shouldn't use modifier 59 to report 38220 and 38221 together if the procedures occur through the same incision.

Just because you can't use modifier 59 to bill 38220 and 38221 together for a bone marrow biopsy and aspiration through the same incision doesn't mean you have no recourse.

Know the G code: For sequenced procedures, you can report the aspiration to Medicare using G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service).

You'll also report 38221 for the biopsy.

HCPCS 2009 highlights G0364 as a "carrier discretion" code. Contact your carrier for specific coverage guidelines before submitting your claim. Commercial and managed care payers may have guidelines that allow you to report 38220 and 38221 for sequenced procedures, or that might require you to report only the most extensive procedure.