Pathology/Lab Coding Alert

Question: Can a hospital bill for the technical component of CPT 85097 when an independent pathologist interprets a bone-marrow aspiration prepared at the facility?


Oregon Subscriber

Answer: Medicare's Physician Fee Schedule does not indicate that you can use the bone-marrow aspiration code (85097, Bone marrow, smear interpretation) with modifier TC (Technical component) and 26 (Professional component). The AMA, however, states that 85097 includes a technical and professional component.

According to the July 1998 CPT Assistant, -If only physician services are performed, then 85097 [is] reported with modifier 26. If technical services (such as staining) are also performed by a physician or the laboratory, then the codes should be used without a CPT modifier.- The AMA's CPT 2006 still references this article, which may be why you wonder if the hospital can bill for the technical component.

For Medicare coverage, clearly you cannot report 85097 with modifier TC to claim the technical service. Other payers also may consider the bone-marrow smear interpretation a professional-only procedure, but some payers may consider the slide preparation a separate technical service. Contact your payers for a policy on this code.

Don't confuse the routine preparation and staining of bone marrow smears with special stains that the pathologist may use. Report special stains separately using the appropriate code, such as 88313 (Special stains [list separately in addition to code for primary service]; group II, all other [e.g., iron, trichrome], except immunocytochemistry and immunoperoxidase stains, each) for iron stains used to evaluate iron-deficiency anemia. The special-stain codes do have a professional and technical component, according to Medicare. If hospital personnel prepare the special-stain slides, the hospital may code 88313-TC for outpatient services.