Oncology & Hematology Coding Alert

Question: We are a free-standing clinic, and one of our physicians tried to perform a bone marrow biopsy at the hospital. After receiving Xylocaine, the patient experienced dizzy spells and confusion. As a result, the procedure was aborted and the patient was rescheduled. The supplies and Xylocaine are provided by the hospital. Is there anything billable by the physician?

Michigan Subscriber

Answer: Typically, when a bone marrow biopsy (85102) is scheduled and performed, the procedure and medications are billed. An evaluation and management (E/M) code such as 99211 is not billed because the exam is part of the procedure. When a physician completes an outpatient biopsy in the hospital setting, the hospital bills for the drugs and technical charges for the bone marrow biopsy, and the physician bills the professional component only. In this case, the procedure was not completed and should not be billed. The physician could bill an E/M visit by appending modifier -26 (professional component) if an exam was completed and appropriately documented.

This question was answered by Margaret Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant and former clinical director of Tulane Cancer Institute in New Orleans.