Pathology/Lab Coding Alert

Reader Question:

Ask Payer for G0364, 38220 Distinction

Question: Should I report G0364 or CPT 38220 for bone marrow aspiration and biopsy at the same session for private payers?Tennessee SubscriberAnswer: You should get your payer's preference in writing and follow the specific instruction for that payer. Generally, when the pathologist performs a bone marrow aspiration and biopsy at the same site during the same session, you should report at least 38221 (Bone marrow; biopsy, needle or trocar) for the biopsy. For private payers who don't accept G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) for same-site, same-session aspiration, you may be able to additionally report 38220 (Bone marrow; aspiration only).In contrast, if you're reporting to Medicare (or a payer that shares Medicare's rules), you should report both 38221 and G0364 to indicate that the pathologist performed the two services through the same incision at the same session.As [...]
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