Oncology & Hematology Coding Alert

Question: At our center, we perform bone marrow aspiration and biopsies, and also perform the labs. If the physician removes and examines bone-marrow aspiration and biopsy specimens from the patient's iliac crest, which CPT codes should we report?

Georgia Subscriber

Answer: Payers rules differ for reporting bone marrow aspiration (38220, Bone marrow, aspiration only) and biopsy (38221, - biopsy, needle or trocar) together.

Many payers will reimburse only 38221 when the physician performs the biopsy and aspiration at the same session and anatomic site.

Medicare must: For Medicare, report the biopsy extraction as 38221 and the aspiration extraction as G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) when the physician performs both services during the same encounter at the same anatomic site.

Bonus 38220 tip: The most recent national Correct Coding Initiative (CCI) edits bundle 38220 into 38230 (Bone marrow harvesting for transplantation); therefore you should report only 38230 for aspiration and harvest performed at the same session. You can't override this edit because CCI gives it a -0- modifier indicator.

Labs: Oncology and hematology practices that don't perform the labs themselves shouldn't report the lab services, but you specify that you perform the labs onsite. You should consider the following codes for the lab services, depending on the documentation:
- 85097 -- Bone marrow, smear interpretation
- 88305 -- Level IV - Surgical pathology, gross and microscopic examination; bone marrow, biopsy.

If the lab also examines a cell block prepared from the bone marrow aspirate, you can bill an additional unit of 88305 (- cell block, any source).