Pathology/Lab Coding Alert

Question: The pathologist examined a bone marrow biopsy from the left iliac crest and a bone marrow aspiration from the right. I know that I cannot report both an aspiration and biopsy from the same site, but can we report two codes since this was from two different sites? Should we use the new HCPCS code?


Missouri Subscriber

Answer: You can report a bone marrow biopsy and bone marrow aspiration together when taken from two separate sites. For the biopsy of the left iliac crest, report 38221 (Bone marrow; biopsy, needle or trocar) for acquiring the specimen and 88305 (Level IV - Surgical pathology, gross and microscopic examination, bone marrow, biopsy) for the pathologist's tissue exam.

For the aspiration from the right iliac crest, report 38220 (Bone marrow; aspiration only) for specimen acquisition and 85097 (Bone marrow, smear interpretation) for the pathology exam.

Because the National Correct Coding Initiative bundles 38220 with 38221, you'll have to use modifier -59 (Distinct procedural service) to indicate that the pathologist examined specimens from two different sites, not an aspiration and a biopsy taken from the same incision.

The HCPCS Level II code you refer to is G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service). You should use this code only when the physician performs a bone marrow biopsy and aspiration through the same incision. Medicare implemented this code beginning in January 2005. Prior to that time, you could not get paid for both a bone marrow aspiration and biopsy through the same incision. Now you should report the service as 38220 for the biopsy, plus G0364 for the aspiration, which pays at a lower rate than 38221.