Oncology & Hematology Coding Alert

The advice youve read and heard about coding bone marrow aspirations and biopsies could be wrong and costing your practice deserved dollars.
 
If your oncologist performs 38220 (Bone marrow; aspiration only) and a 38221 ( biopsy, needle or trocar) on the same date of service for the same patient, you should report only the biopsy, unless your physician performed two different incisions. Thats because the National Correct Coding Initiative ( NCCI Edits ) bundles 38220 and 38221 and allows for unbundling only on the condition that the procedures occur through separate incisions or during different patient encounters.
 
You can separately report 38220 and 38221 if the physician performs two different punctures (meaning the aspiration and biopsy involve two different bone marrow sites) even if the physician goes through only one incision, says Martin Neltner, president of Neltner Billing & Consulting in Independence, Ky.
 
Also, the American Medical Association added the word only to this years descriptor of 38220, so you should use this code only when your oncologist documents that small pieces of bone were aspirated with a needle or trocar, says Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga. Report 38221 to describe the marrow aspiration, she says. Report 2 Punctures (2 Sites) as 2 Procedures When you report biopsy and aspiration separately to Medicare or private carriers, report 38221 first because CMS places a greater value on that code, Lively says. Most local carriers havent published definitive guidelines regarding 38220 and 38221, so bill the procedures separately until your carrier rejects them or creates guidelines, she says.
 
If Medicare or your local carrier rejects your claims, use modifier -59 (Distinct procedural service). According to NCCI, you can separately report these codes using modifier -59 only if your physician performed two separate and distinct procedures, says Jan Beach, CMM, CPC, LHRM, administrator of Hematology-Oncology Practice in Vero Beach, Fla.
 
Distinct procedures for 38220 and 38221 involve two separate access sites (punctures), she says. In other words, if the physician goes into two different sites of the bone marrow and retrieves two different specimens (aspiration and biopsy), you should report these procedures separately, regardless of whether your physician performs them through the same incision or two. Follow These Steps to Justify Unbundling Your physicians documentation of the procedures technique is the key to unbundling these procedures and getting paid, Neltner says. Your physicians dictation must note that the aspiration and biopsies occurred in different sections of the bone marrow, through different withdrawal accesses (different punctures), for example by stating, I did the [...]