Oncology & Hematology Coding Alert

Question: A patient underwent a bone marrow aspiration and biopsy and the oncologist performed each service from two different sites. I'm not sure if I should code this as one operation or bundle these codes to reflect both the biopsy and aspiration – what should I do?

Texas Subscriber

Answer: Your example mentions the procedures were performed at "two different sites." Before you make a coding decision, you need to know whether the second site was within the same or two separate surgical fields. Some in the industry consider two incision sites within the same surgical field a separate site. However, this is one area of focus where the specific distinction is important. If in fact, the sites are justifiably separate, report both procedures with 38221 (Bone marrow; biopsy, needle or trocar) and 38220 (Bone marrow; aspiration only) appending modifier 59 (Distinct procedural service) or modifier XS (Separate structure), XP (Separate practitioner), XE (Separate encounter) or XU (Unusual non-overlapping service) as appropriate for Medicare and other carriers who prefer these HCPCS modifiers in place of modifier 59. Therefore the codes to report in total are 38221 (Bone marrow; biopsy, needle or trocar), 38220-59 (or XS, XP, XE, XU) (Bone marrow; aspiration only) to represent all procedures involved.

Note: If you are unfamiliar with the other HCPCS modifiers mentioned, XS, XP, XE and XU in place of modifier 59, take time to research their specific circumstances for use and be aware Medicare, and some other payors, do prefer HCPCS modifiers XS, XP, XE or XU in place of modifier 59 since they describe a more specific reason for requesting separate payment for two services that are otherwise bundled.

If the physician performs both procedures through the same incision or within the same surgical field, 38220 and 38221 are bundled. The National Correct Coding Initiative (CCI) instructs you to report only the bone marrow biopsy with CPT^® code 38221 when an aspiration and bone marrow biopsy are performed on the same site through the same skin incision/same surgical field. Medicare will also allow the add-on HCPCS code G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) which holds a nominal relative value unit (RVU) value of 0.25 to 0.35 RVUs allowing additional reimbursement in the facility or office locations respectively.