Pathology/Lab Coding Alert

Use Medicare's proposed G code

When your pathologist procures a bone marrow aspiration specimen through the same incision as a bone marrow biopsy specimen, you've had to eat the cost - until now.

New way: Come Jan. 1, 2005, you should have a new code to capture the additional aspiration work, if Medicare follows through with its proposal in the Aug. 5 Federal Register.

Medicare prohibits reporting together CPT 38220 (Bone marrow; aspiration only) and 38221 (... biopsy, needle or trocar) when the physician extracts both specimens through the same incision on the same day. "Currently, you'll only get paid for the most extensive procedure (38221), even if you perform both an aspiration and a biopsy," says R.M. Stainton Jr., MD, president of Doctor's Anatomic Pathology, an independent pathology laboratory in Jonesboro, Ark.

List G Code for Aspiration Add-On

You'll use Medicare's new proposed G code as an add-on. Report 38221 for the biopsy, and also report G0xx1 (Bone marrow aspiration) - CMS hasn't yet assigned the complete HCPCS level II code number - for the aspiration performed through the same incision.

The good news is that Medicare will begin to pay pathologists for the additional aspiration service. The bad news is that Medicare won't pay very much. Code 38220 has 1.08 work relative value units, and Medicare proposes 0.16 work RVUs for the new G code.

That means a bone marrow aspiration sequenced after a biopsy will pay a fraction of what it would pay as a stand-alone service. "But remember, you should be comparing the G-code payment with nothing, which is what Medicare currently pays for a bone marrow aspiration taken in the same session as a biopsy," Stainton says.

Different Sites Are a Different Story

Don't apply these rules if the pathologist performs a bone marrow biopsy and bone marrow aspiration from different anatomic sites.

"The new G code will only apply when the pathologist procures the bone marrow biopsy and aspiration through the same incision," Stainton says.

If the pathologist performs a biopsy and aspiration on two different sites, such as bilateral iliac crests, you should report 38221 and 38220 with modifier -59 (Distinct procedural service) to indicate that you performed the procedures at different sites.