Oncology & Hematology Coding Alert

Question: Oncologists on our medical staff believe they can bill the following procedures for the same patient, same encounter and same date: Bone marrow aspiration Bone marrow aspiration for chromosomes Bone marrow biopsy, right iliac crest Bone marrow biopsy, left iliac crest Although this may have been true in the past, is it correct to code only 38221 (Bone marrow biopsy, needle or trocar)? New Jersey Subscriber Answer: From Medicare's perspective, the biopsy and aspiration are the same because the two samples marrow and bone are drawn from the same incision and removed from the same site, often from the same needle. The Correct Coding Initiative (CCI) directs carriers to pay for the biopsy but not the aspiration if both procedures are reported together. That means you can bill 38220 (Bone marrow aspiration) or 38221. Although oncologists have argued unsuccessfully that biopsies and aspirations, although closely related, are separate procedures, separating payment is inappropriate unless each procedure is performed on separate sites. You can override CCI bundling by appending modifier -59 (Distinct procedural service) to one of the codes. To appropriately apply modifier -59, the oncology practice must be able to prove that 38220 and 38221 are separate in the context of Medicare's interpretation. If the biopsy and aspiration were taken from separate sites from each side of the hip, for example they can be interpreted as being separate procedures.

To get paid for both bone marrow aspiration and bone marrow biopsy, some oncology practices report 20220 (Biopsy, bone, trocar, or needle; superficial [e.g., ilium, sternum, spinous process, ribs]) with 38220. Although CCI does not bundle 20220 and 38220, the biopsy code is inappropriate. Code 20220 is reserved for bone biopsies, not bone marrow biopsies. Some physicians may argue that bone marrow is part of the bone, which justifies using 20220. Code 38220 differs from 20220 because 20220 requires the physician to obtain a sample of compact or hard bone from the bone cortex.