38220 vx 38221 (Bone marrow asp & biopsy)


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Could any one please help me? I have started a new position as coding coordinator for an oncology group. The billing specialists tell me they have always billed for 38220 (bone marrow;aspiration only) and 38221 (bone marrow;biopsy, needle or trocar) and gotten paid for both. 38220 is a component of 38221, so I contend that only the 38221 should be billed.

The procedure note states "Patient was draped and prepped under local anesthetic with 1% lidocaine and bicarbonate. After informed consent, bone marrow was aspirated from the left posterior iliac crest. A bone marrow biopsy was then obtained from the posterior iliac crest and the specimen was sent for bone marrow aspirate and biopsy, flow cytometry and crtogenetics."

What do you think??
You can only bill a 38220 with a 38221 if the physician removes the needle after the aspiration is done and then places the needle back in at a different location to do the Biopsy. You have to use a 59 modifer to the 38220. If the physician does not mention that the needle was removed and then replaced your cpt codes should be G0364 and 38221.

Teresa K. Vaughn CPC,RCC
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