Oncology & Hematology Coding Alert

When the definition says "bilateral," it means "bilateral." Don't append modifier -50 (Bilateral procedure) to two different procedures unless performed on identical anatomic sites on opposite sides of the body.

Use modifier -50 for bilateral bone marrow biopsies or aspirations if the sites are, in fact, bilateral not just separate sites and the physician performed the exact procedure on both sides. A correctly reported bilateral service would be: The physician performs a bone marrow biopsy and aspiration in the same incision on the right and left iliac crest. (That's two incisions, but after each one, the physician performs a biopsy and aspiration.)

You should report the biopsy code, 38221, with modifier -50, says Carolyn M. Davis, CCP, CCS-P, the billing supervisor for Oncology Hematology West in Papillion, Neb. You have two technically bilateral sites (modifier -50) that each involved a bundled biopsy and aspiration procedure, 38221. An incorrectly reported bilateral service would be: The physician performs a bone marrow aspiration on the left iliac crest and an aspiration and biopsy in the same incision on the right iliac crest. If you report any of these codes with modifier -50, you're incorrect because your physician hasn't performed the exact total procedure on both sides. You should instead report the biopsy, 38221 (the aspiration is bundled in), for the right side's procedures and 38220 with modifier -59 (Distinct procedural service) for the left, Davis says.

Watch our for payer preferences when you report bilateral procedures. Some payers require that you report these procedures with site modifiers -LT and -RT, the HCPCS alpha-modifiers, says Marcella Bucknam, CPC, CCS-P, CPC-H, HIM program coordinator at Clarkson College in Omaha, Neb. Some payers may request that you instead use modifier -59 on both the biopsy and aspiration codes to report services done on bilateral sites, she says. Ask your payer how it recognizes bilateral procedures.