Pathology/Lab Coding Alert

Question: We sometimes perform bone marrow aspirations or biopsies bilaterally, one each from the left and the right iliac crest for cancer staging. In the past year, we have had problems with Medicare denying the claims, stating "payment adjustment for bilateral procedures does not apply." Why has Medicare's coverage changed, and can we do anything to get paid for these services?

Florida Subscriber

Answer: The 2002 Physician Fee Schedule contained errors in the "bilateral procedure modifier" column that were corrected in program memorandum AB-02-112 (July 31, 2002). The codes for bone marrow aspiration (38220, Bone marrow aspiration) and bone marrow biopsy (38221, Bone marrow biopsy, needle or trocar) were among the codes that contained the error. These codes were listed with bilateral modifier indicator "0," meaning that even if performed bilaterally, they are paid at the fee schedule amount of the single code.

The program notice changed the bilateral modifier indicator of codes 38220 and 38221 to "1," meaning that if you bill the code twice on the same day, you should be paid at 150 percent of the fee schedule amount for the single code. The trick will be getting those claims corrected. Although the program memo makes the corrected modifier indicator retroactive to Jan. 1, 2002, carriers are under no obligation to revise payment for claims already filed. You must file a new claim to receive corrected payment.

Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.; and Laurie Castillo, MA, CPC, CPC-H, CCS-P, member of the National Advisory Board of the American Academy of Professional Coders and president of Physician Coding and Compliance Consulting in Virginia