Pathology/Lab Coding Alert

Question: When our pathologist examines a bone marrow aspirate and bone marrow biopsy, our MAC is denying 38221 and gives us a message about billing with a modifier. What is the correct coding for this scenario?

Illinois Subscriber

Answer: Medicare restricts reporting together a bone marrow biopsy (38221, Bone marrow; biopsy, needle or trocar), and bone marrow aspiration (38220, ... aspiration only) when taken through the same incision.

You can only bill both codes together if the specimens are from separate sites or separate patient encounters. In those circumstances, you should report 38221 and 38220-59 (Distinct procedural service).

If the specimens are from the same site, you can bill both the aspiration and the biopsy to Medicare using 38221 for the biopsy, and G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) for the aspiration.