Oncology & Hematology Coding Alert

Say goodbye to modifier -51 (Multiple procedures) and hello to modifier -59 (Distinct procedural service) when you report bone marrow biopsies and aspirations separately but remember, you must jump through unbundling hoops to score payment on -59.

In a recent issue of Oncology Coding Alert, experts warned you to use caution when reporting modifier -51 for these services. (See "Highlights from the 2003 Physician Fee Schedule: Bone Marrow Aspiration and Biopsy Blues Remain" from the February 2003 issue of Oncology Coding Alert.) This month, experts are back to tell you definitively: Do not use modifier -51 to separate biopsies and aspirations. Instead, look to modifier -59. Modifier -59: 'Distinct'Is Key Breaking up is hard to do and it could cost you money. If you report bone marrow aspirations, 38220 (Bone marrow; aspiration only), and biopsies, 38221 (... biopsy, needle or trocar), separately, you could face denials in certain situations because you are violating bundling rules.

The National Correct Coding Initiative edits bundle 38221 and 38220 together. The edits allow you to unbundle them but only if they're distinct procedures as indicated by the number 1 next to the codes listed in the edits, says Martin Neltner, a consultant with Neltner Billing & Consulting in Independence, Ky.

You can report these bone marrow codes separately as distinct procedures if the procedures are for the same patient and involve one of the following:
different incisions
different anatomical sites
different patient encounters involving distinct procedures, says Carolyn M. Davis, CMA, CPC, CCP, CCS-P, CPHT, TMC, the billing supervisor for Oncology Hematology West in Papillion, Neb., and a professional coding and continuing education instructor at Iowa Western Community College.

According to the NCCI guidelines, when you report these codes separately, you should append modifier -59, she says. Add it to the secondary service. If your physician's work doesn't meet unbundling criteria, however, you should not report these codes separately, Neltner says. Instead report the biopsy code, 38221, alone it covers both procedures. The following three examples show you when you can and can't unbundle biopsies and aspirations with modifier -59. Example #1: A patient presents to the clinic, and your physician performs a bone marrow aspiration and biopsy of the right iliac crest. These procedures occur in the same site, in the same bone, during the same patient encounter. You cannot unbundle these procedures. You should report only 38221, Davis says. Example #2: The physician performs the same procedures in Example #1 but also does a bone marrow aspiration on the sternum's left side. As stated in the previous example, you cannot unbundle the procedures on the right side.

You can, however, report the aspiration on the left side separately from the biopsy [...]