Oncology & Hematology Coding Alert

Question: How should I code a bone marrow biopsy with aspiration?

Illinois Subscriber


Answer: The answer depends on your payer. For Medicare, you should report 38221 (Bone marrow; biopsy, needle or trocar) and G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service).

For non-Medicare payers, you typically report 38221 alone -- these payers may bundle in the service described by 38220 (Bone marrow; aspiration only).

Red flag: The Office of Inspector General's 2005 report on modifier 59 (Distinct procedural service) revealed that in their test sample, coders most often used modifier 59 inappropriately with the 38221-38220 National Correct Coding Initiative edit. The problem: You can't override the edit when the aspiration and biopsy are performed at the same session and through the same incision.

Lesson: Only when the biopsy and aspiration are at separate sites or performed at separate encounters should you consider overriding the edit and reporting 38221 and 38220-59.