Pathology/Lab Coding Alert

Maneuver coding restrictions with modifier and G code

If you're reporting a bone marrow biopsy and a bone marrow aspiration together, you need to know Medicare's restrictions for surgical codes 38220, 38221 and G0364, as well as pathology codes 88305 and 85097 if you want to recoup full payment.

Through HCPCS coding and National Correct Coding Initiative (NCCI) edits, Medicare restricts payment for bone marrow biopsy and aspiration. "But because a bone marrow biopsy and a bone marrow aspiration can provide different diagnostic information for the evaluation of cancers such as myeloid leukemia (205.xx, Myeloid leukemia), pathologists frequently analyze both specimens together," says R.M. Stainton Jr., MD, president of Doctor's Anatomic Pathology, an independent pathology laboratory in Jonesboro, Ark.

That's why you'll need to know the following coding restrictions:

Separate Incision Trumps NCCI Edit Medicare prohibits reporting together codes 38220 (Bone marrow; aspiration only) and 38221 (... biopsy, needle or trocar) when the physician extracts both specimens through the same incision on the same day.

An NCCI edit bundles these codes, and the National Correct Coding Policy Manual states that you may only report 38220 and 38221 together if the physician performs the procedures at different patient encounters, or "in different bones or two separate skin incisions over the same bone."

If the procedures meet one of these criteria, you'll have to override the NCCI edit with modifier -59 (Distinct procedural service) to get paid for both services, Stainton says. Report New G Code for Same Incision Beginning Jan. 1, Medicare implemented a new code for a bone marrow aspiration sequenced after a bone marrow biopsy through the same incision.

Prior to adding G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service), pathologists could only charge for the biopsy (38221) when taking both a biopsy and an aspiration from the same incision. "Now you can recoup some pay for the additional work the pathologist performs to procure both specimens," Stainton says.
 
New way example: The pathologist takes a bone marrow biopsy using a trocar through a small incision over the left iliac crest. The pathologist also performs a needle aspiration through the same incision to enhance evaluation of bone marrow cytologic detail. "Report the biopsy as 38221, and also report new code G0364 for the bone marrow aspiration," says Beverly Bloedow, coding resource specialist for Hospital Pathology Associates in Minneapolis.

Watch for: NCCI bundles 38220 and G0364 as a mutually exclusive edit pair. You must choose one code [...]