Pathology/Lab Coding Alert

Question: Our pathologist removed and examined bone-marrow aspiration and biopsy specimens from the right iliac crest. Can we bill for both extractions and both specimen exams?


Florida Subscriber

Answer: You can bill for both extractions and both specimen exams, although how you code the extraction will depend on the payer.

List both exams: You should report the following two codes for the pathologist's exam and diagnosis of the bone marrow aspirate and biopsy:

- 85097--Bone marrow, smear interpretation

- 88305--Level IV--Surgical pathology, gross and microscopic examination, bone marrow, biopsy.

Opportunity: If the pathologist also examines a cell block prepared from the bone marrow aspirate,  you can bill an additional unit of 88305 ( Level IV--Surgical pathology, gross and microscopic examination, cell block, any source).

List both extractions: Two separate CPT codes describe extraction of bone marrow biopsy and aspirate specimens:

- 38220--Bone marrow; aspiration only

- 38221--Bone marrow; biopsy, needle or trocar.

Caution: Medicare and some other payers do not allow you to report both codes when the physician performs both procedures through the same incision. Your question indicates that both specimens came from the same site.

Do this: For Medicare, report the biopsy extraction as 38220 and the aspiration extraction as G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service). Medicare pays G0364 at a lower rate than 38221.