Oncology & Hematology Coding Alert

Question: A patient comes in for a bone marrow test, but the doctor cannot reach the bone because the patient is obese. He reviews the laboratory test with the patient and proceeds with the test, but it is not completed. How should this be coded for Medicare?

Colorado Subscriber

Answer: If a bone marrow aspiration (85095) or biopsy (85102) was begun but not completed (i.e., the skin was incised or a needle was inserted), appending modifier -53 (discontinued procedure) may be appropriate. The CPT definition for modifier -53 states that Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well-being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This may be reported by adding modifier -53 to the discontinued procedure code.

But appending modifier -53 may not be the deciding factor for reimbursement. The Medicare Carriers Manual in the Fee Schedule for Physicians Services, section 15900, addresses modifier -53 by stating, ... codes billed with this are subject to carrier medical review and priced by individual consideration.

In this instance, the proper coding for a bone marrow aspiration is 85095 with modifier -53. To withstand review of this claim, the patient record should include notes describing the procedure and when it was terminated. A description of the patients obesity and the physicians problem should also be included.


Questions answered by Ris Marie Cleland, co-founder of Oplinc Oncology Services, a coding consulting firm in Lawton, Okla.; Laurie Lamar, RHIA, CCS, CTR, CCS-P, assistant director of reimbursement, public policy and practice department of the American Society of Clinical Oncology in Alexandria, Va. Her position does not reflect the opinion of ASCO; Elaine Towle, CMPE, practice administrator for New Hampshire Oncology and Hematology in Hooksett, N.H.; and Margaret Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant and former director of the Tulane Cancer Center in New Orleans.