Oncology & Hematology Coding Alert

Question: According to CCI edits, we can bill 38221 with 38220 and modifier 59, but I continue to receive denials from Medicare for 38220-59. Do you have any advice?

Washington Subscriber

Answer: Coding edits might allow you to bill 38220 (Bone marrow; aspiration only) with 38221 (- biopsy, needle or trocar), but that's not your best tactic. If your physician completes a bone marrow aspiration and biopsy during the same encounter (and uses the same incision for both procedures), report 38221 for the biopsy, but change your aspiration code. Instead of 38220, report G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service).

G code note: HCPCS 2009 highlights G0364 as a "carrier discretion" code. Contact your carrier for specific coverage guidelines before submitting your claim. Remember that commercial and managed care payers have their own guidelines. If the patient does not have Medicare, codes 38220 and 38221 may be bundled, and you might not be able to bypass the bundling edit to report both codes.

Check for modifiers: There might be times when your oncologist completes bilateral biopsies and aspirations. In that case, you would need modifier 50 (Bilateral procedure) for one set of codes to show two procedures. You may also need to append modifiers RT (Right side) and LT (Left side) for further illustration, depending on your payer's guidelines.