Oncology & Hematology Coding Alert

Question: Our physician performs a bone marrow aspiration and biopsy for a Medicare beneficiary. How can we best report these services, 38221and 38220 or G0364? 

Georgia Subscriber

Answer: Decide the best code(s) depending on whether your physician performs the aspiration and biopsy through the same or separate incisions, even if they’re from the same bone.

Check the incisions: If your physician performs the aspiration and biopsy through the same surgical field on the same targeted bone even if not the same incision, you should report 38221 (Bone marrow; biopsy, needle or trocar) for the biopsy and G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) for the aspiration. On the other hand, if your physician performs the biopsy and aspiration on different bones or through separate incisions on the same bone, you should still report the biopsy using 38221, but you should code the aspiration using 38220 (Bone marrow; aspiration only).

Watch for the bundle: Medicare’s Correct Coding Initiative (CCI) bundles 38220 as a column 2 code for 38221, so you can’t report these two codes together unless you have documentation of different sites or surgical sessions, and you’ll have to use a modifier, such as 59 (Distinct procedural service). 

You can report a single procedure: If your physician performs only a bone marrow biopsy or aspiration, for Medicare and other payers, you should list 38220 alone for the bone marrow aspiration, and 38221 alone for the bone marrow biopsy.