Pathology/Lab Coding Alert

Maneuver coding restrictions with modifier and G code

If you're reporting a bone marrow biopsy and a bone marrow aspiration together, you need to know Medicare's restrictions for surgical codes 38220, 38221 and G0364, as well as pathology codes 88305 and 85097 if you want to recoup full payment.

Through HCPCS coding and National Correct Coding Initiative (NCCI) edits, Medicare restricts payment for bone marrow biopsy and aspiration. "But because a bone marrow biopsy and a bone marrow aspiration can provide different diagnostic information for the evaluation of cancers such as myeloid leukemia (205.xx, Myeloid leukemia), pathologists frequently analyze both specimens together," says R.M. Stainton Jr., MD, president of Doctor's Anatomic Pathology, an independent pathology laboratory in Jonesboro, Ark.

That's why you'll need to know the following coding restrictions:

Separate Incision Trumps NCCI Edit

Medicare prohibits reporting together codes 38220 (Bone marrow; aspiration only) and 38221 (... biopsy, needle or trocar) when the physician extracts both specimens through the same incision on the same day.

An NCCI edit bundles these codes, and the National Correct Coding Policy Manual states that you may only 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."

If the procedures meet one of these criteria, you'll have to override the NCCI edit with modifier -59 (Distinct procedural service) to get paid for both services, Stainton says.

Report New G Code for Same Incision

Beginning Jan. 1, Medicare implemented a new code for a bone marrow aspiration sequenced after a bone marrow biopsy through the same incision.

Prior to adding G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service), pathologists could only charge for the biopsy (38221) when taking both a biopsy and an aspiration from the same incision. "Now you can recoup some pay for the additional work the pathologist performs to procure both specimens," Stainton says.
 
New way example: The pathologist takes a bone marrow biopsy using a trocar through a small incision over the left iliac crest. The pathologist also performs a needle aspiration through the same incision to enhance evaluation of bone marrow cytologic detail. "Report the biopsy as 38221, and also report new code G0364 for the bone marrow aspiration," says Beverly Bloedow, coding resource specialist for Hospital Pathology Associates in Minneapolis.

Watch for: NCCI bundles 38220 and G0364 as a mutually exclusive edit pair. You must choose one code or the other to describe the physician's bone-marrow cell extraction. "Choose the proper code based on whether the pathologist performed the aspiration in conjunction with the biopsy (G0364) or as a stand-alone procedure (38220)," Bloedow says.

Other payers may or may not follow Medicare coding for a bone marrow biopsy and aspiration from the same incision - you'll have to consult with individual payers to determine their requirements.

Choose From 2 Bone Marrow Exam Codes 

Don't confuse the codes for procuring bone-marrow biopsy and aspiration with the codes for examining those specimens.

CPT provides different codes for the pathologist's examination of bone marrow biopsy and bone marrow aspiration specimens:

 88305 - Level IV - Surgical pathology, gross and microscopic examination, bone marrow, biopsy

 85097 - Bone marrow, smear interpretation.

You should choose the appropriate code based on the type of specimen the pathologist examines. "If the pathologist receives two separate specimens - one bone marrow aspiration and one bone marrow biopsy - you should report 85097 and 88305 together for the two examination services," Stainton says.

Don't overlook: If the pathologist performs and documents ancillary services for processing and evaluating the bone marrow specimens, you should separately report those services as well.

Examples of codes the pathologist might report in addition to 88305 and 85097 for bone marrow specimens include the following:

 +88311 - Decalcification procedure (list separately in addition to code for surgical pathology examination)

 +88312-+88314 - Special stains (list separately in addition to code for primary service); ...

+ 88305 - ... cell block, any source.