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Oncology & Hematology Coding Alert

Reader Question:

Biopsy + Aspiration Does Not Equal Multiple Procedures

Published on Mon Nov 15, 2004

Question: If an oncologist performs a bone marrow aspiration and a biopsy on the same patient in the same session, can I report both codes using modifier -51 (Multiple procedures)?

Minnesota Subscriber Answer: Reporting two codes in this instance, modifier or no modifier, would be fraudulent. On the claim, you should file only 38221 (Bone marrow; biopsy, needle or trocar).

Explanation: You should never report a bone marrow biopsy and aspiration separately, because you have to perform an aspiration to get a sample for the biopsy; thus, the aspiration is considered an integral part of the biopsy.

Exception: However, if the biopsy and aspiration are from two different sites or if they occur in two separate patient encounters, you may be able to report both services using modifier -59 (Distinct procedural service).
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