Bone marrow biopsy and aspiration

[tonplair@gmail.com]

I have a doctor her that just started and we have been billing bone marrow biopsy using just the 38221 cpt unless its medicare then we add g0364 hcpc code. The new dr. Thinks we should be able to bill 38221 and 38220 but he only make one incision but goes into 2 place of the bone. I was always told to only bill 38221 unless they make 2 separate incision and then that will be the only way to bill 38220 and that it has to be documented in op note that he made two separate incision. Can someone give me some insight on how bone marrow should be bill or if i am billing it correctly with one incision and using 38221?

 

[traci.susong@gmail.com]

Is your doctor performing aspirations also? My doctor does the aspiration and biopsy through one incision and we bill 38221 & G0364 for commercial and Medicare and 38220 and 38221 for Medicaid.

 

[Wendy CPC]

This is how we bill...

Medicare rule…..

As of January 1, 2005, Medicare created a new G-code (G0364) to report a bone marrow aspiration performed on the same date through the same incision as a bone marrow biopsy. G0364 is to be reported with the bone marrow biopsy code, 38221.
If the biopsy and aspiration are performed through different incisions or different patient encounters on the same day, then Medicare will make separate payments for each procedure. When billing for both the bone marrow aspiration (38220) and bone marrow biopsy (38221) codes on the same date of service, the -59 modifier is required. In these cases, the multiple procedure rule will apply and documentation in the medical record should support the billing.

Commercial payor rule…

When bone marrow aspiration is performed alone, the appropriate code to report is CPT code 38220. When a bone marrow biopsy is performed, the appropriate code is CPT code 38221 (bone marrow biopsy). CPT codes 38220 and 38221 may only be reported together if the two procedures are performed at separate sites or at separate patient encounters. Separate sites include bone marrow aspiration and biopsy in different bones or two separate skin incisions over the same bone. When both a bone marrow biopsy (CPT code 38221) and bone marrow aspiration (CPT code 38220) are performed at the same site through the same skin incision, only the bone marrow biopsy (CPT 38221) should be reported.

 

[traci.susong@gmail.com]

Our commercial payer contracts require 38221 and G0364... I initially coded 38220 & 38221 (and told my biller to code it this way) but was told by my managed contracting department that per our payers, that was incorrect...