Pathology/Lab Coding Alert

Question: When our pathologist performs a bone marrow aspiration and biopsy for a Medicare patient, we bill 38221 and 38220-59 since Correct Coding Initiative (CCI) edits indicate that we can override the edit pair. Were still getting denials -- do you have any advice?

Maryland Subscriber

Answer: Coding edits might allow you to bill 38220 (Bone marrow; aspiration only) with 38221 (& biopsy, needle or trocar), but thats not your best tactic. If your pathologist completes a bone marrow aspiration and biopsy during the same encounter (and uses the same incision for both procedures), report 38221 for the biopsy, but change your aspiration code. Instead of 38220, report G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service).

HCPCS 2009 highlights G0364 as a carrier discretion code. Contact your carrier for specific coverage guidelines before submitting your claim. Remember that commercial and managed care payers have their own guidelines. If the patient does not have Medicare, another payer may bundle codes 38220 and 38221 and you might not be able to report both codes.

If youre also billing for the pathology examination of these specimens, you should report the following codes:

" 85097 -- Bone marrow, smear interpretation

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

If the lab also examines a cell block prepared from the bone marrow aspirate, you can bill an additional unit of 88305 (& cell block, any source).