Wiki Bone marrow bx/aspiration ? - When billing medicare should

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cpccoder2008

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When billing medicare should you use G0364 for a bone marrow bx and aspiration ? Or should you use 38221 ? On another oncology forum someone stated they use G0364 and 38221 for all patients with -59. I don't think i agree with that. It seems that you would be double billing the patients. I'll paster that question also to see what other's think.


Thanks

We are having a discussion in our office regarding coding of bone marrow
biopsy and aspirate coding. My contention is that we should bill all
carriers G0364 (aspirate w/ biopsy) + 38221 biopsy when aspirate/biopsy
done at same site. The only time we would bill 38220 (aspirate only) +
38221 would be if aspirate done on left iliac crest and biopsy done on
the right or if aspirate was done at different anatomical site than the
biopsy.

U r correct
Plus there should be 59
 
G0364

I also bill G0364 to all payors along with the biopsy. It is never a separate site to warrant 38220
 
bone marrow

I code for 38221 and 38220-59 when my physician uses seperate incisions.
He numbs the area, inserts the aspiration needle and extracts it. Then he inserts new biopsy needle in same general area to get a sample. Under modifier -59 rules it says that it's ok to do this since it's the same iliac crest but different incisions.

I code 38221 and G0364 when my physician uses the same incision and same needle to aspirate and get biopsy.


http://www.cms.hhs.gov/NationalCorrectCodInitEd/Downloads/modifier59.pdf

Hope this was helpful.
 
bone marrow

If it's the same iliac crest, how can you call that 'two separate incisions'?
 
You will only bill 38221, this code includes the aspiration and Biopsy. If they only did an aspirtation without a biopsy, then you will only bill 38220.
 
I agree with ktricia; the same iliac crest is not a separate location. I would not consider two needle punctures to be two "incisions". These specific codes are discussed in the CCI edits.

E. Hemic and Lymphatic Systems
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). This code cannot be reported with CPT code 20220 (bone 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, do not report the bone marrow aspiration, CPT code 38220, in addition to the bone marrow biopsy (CPT code 38221). HCPCS/CPT code G0364 may be reported to describe the bone marrow aspiration performed with bone marrow biopsy through the same skin incision on the same ate of service.
 
Same site

My doctor always performs a biopsy and aspiration together through the same site. I was told to use G0364 and 38221 for medicare & insurance carries and just 38221 for all others (medicaid, self pay etc)
 
Different bone ?

What would be considered a different bone ? A completely different bone or a seperate site on the iliac creast ? I would say a completely differnt bone but my physician's thinks otherwise. He makes one incision, performs the aspiration, removes that sample, then inserts another needle and performs the biopsy in a different spot but same bone. I don't think this would justify a -59 but he seems to think since it's a seperate site you can. I printed the article from CMS stating seperate bones, it clearly states Separate sites include bone marrow aspiration and biopsy in different bones or two separate skin incisions over the same bone. Thanks
 
Hi! I'm not a coder for this speciality but asking for a friend of mine......is an E/M visit allowed (new patient) when a biopsy is performed??? If so, modifier 25?


Thanks!!!
 
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