Pathology/Lab Coding Alert

Beware of NCCI 'G' code bundles

Medicare created new HCPCS Level II codes for injection and IV infusion - but many pathology procedures already include the "needle" services, according to the latest NCCI edits, so you can't bill them separately. NCCI version 11.0 took effect Jan. 1.

Aspirations, Transfusions Include Needle Codes

NCCI 11.0 bundles three new "G" codes for injection and IV infusion. "Don't report the following codes for any service that already includes an injection or IV infusion service, says Laurie Castillo, CPC, CPC-H, CCS-P, owner of Castillo Consulting in Manassas, Va.:

G0345 - Intravenous infusion, hydration; initial, up to one hour

G0347 - Intravenous infusion, for therapeutic/diagnostic (specify substance or drug); initial, up to one hour

G0351 - Therapeutic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular.

NCCI bundles the relevant G codes with the following codes for fine needle aspiration (FNA), apheresis, bone marrow transplant services, stem-cell harvesting, and certain transfusion medicines:

10021 - Fine needle aspiration; without imaging guidance

10022 - ... with imaging guidance

36511 - Therapeutic apheresis; for white blood cells

36512 - ... for red blood cells

36513 - ... for platelets

36514 - ... for plasma pheresis

36515 - ... with extracorporeal immunoadsorption and plasma reinfusion

36516 - ... with extracorporeal selective adsorption or selective filtration and plasma reinfusion

36522 - Photophoresis, extracorporeal

38205 - Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogenic

38206 - ... autologous

38230 - Bone marrow harvesting for transplantation

38240 - Bone marrow or blood-derived peripheral stem cell transplantation; allogenic

38241 - ... autologous

38242 - ... allogeneic donor lymphocyte infusions

86890 - Autologous blood or component, collection processing and storage; predeposited

86891 - ... intra- or postoperative salvage

86950 - Leukocyte transfusion.

Choose 1 Bone Marrow Aspiration Code

When the pathologist performs a bone marrow aspiration and bone marrow biopsy through the same incision, Medicare now instructs you to report the aspiration using new code G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service).

NCCI 11.0 lists this code as mutually exclusive with the CPT code for bone marrow aspiration: 38220 (Bone marrow; aspiration only).

That's because the pathologist would only perform one of these procedures for the same patient on the same day. "As with the other mutually exclusive edit pairs, the point is that you must chose only one code - either the pathologist performed the aspiration in conjunction with the biopsy (G0364) or he performed it as a stand-alone procedure (38220)," Castillo says.