G0364- BONE MARROW ASPIRATION- help please

[Wendy3221]

I am trying to determine if you code the 38221 and the G0364 together or if the G0364 is in place of the 38221. I have also read the G0364 is for a second bone marrow aspiration, so if they only do one and patient has Medicare then would I still only code the 38221- any help on this would be greatly appreciated, thanks

 

[Dlgonzalez]

Bone marrow aspiration

G0364 is used when you bill Medicare for an aspiration alone. If the physician performs the bx and asp use 38221 for the asp and 38220 for the bx even if you are billing Medicare. I don't believe you can charge for two aspirations during the same procedure unless the physician re-inserts the needle in a different location, then you could charge it with a 59 modifier. I've never heard of that happening and would wonder about medical necessity.

 

[Wendy3221]

but if the 38221 has the aspiration bundled into it, why would i report it again? i found somewhere that it states for additional aspiration of bone marrow

 

[lpetrova]

Most providers do the biopsy and aspiration the same: anesthetize, may incision, insert 15-gauge Rosenthal aspiration needle and obtain aspirate, remove, insert 11-gauge biopsy Jamshidi needle (same incision), obtain biopsy and remove.

On occasion bilateral biopsies (diagnosis dependent) are needed. In this case 2 procedures are performed on 2 separate sites. This is rare and should be documented as bilateral bone marrow aspirate and biopsy.

So, when the insurance is Medicare and both the aspiration and biopsy are done through the same incision you would report 38221 and G0364. If both are performed on a patient with commercial/managed care insurance using the same incision, then you would onlyreport 38221 (since 38220 is bundled per CCI edits). Some commercial/managed care payers may recognize G0364.

If both services are performed in different ‘sites' (meaning “in different bones or two separate skin incisions over the same bone.”) or encounters then you would report 38221 and 38220 -59 to all payers (including Medicare). Documentation will need to support the ‘separate site' in order to justify appending modifier -59.

Additional 59 support: CMS posted “Modifier 59 Article: Proper Usage Regarding Distinct Procedural Service” on its CCI overview Web page
<http://www.cms.hhs.gov/NationalCorrectCodInitEd/>.

In one study, the Office of Inspector General (OIG)<http://oig.hhs.gov/oei/reports/oei-03-02-00771.pdf> found that coders inappropriately used modifier 59 more often with 38220/38221 than any other code pair. So you want to take extra care to append modifier 59 only when appropriate.

Best regards -

 

[armen]

38221 Bone marrow; biopsy, needle or trocar
G0364 Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service

I agree with the person above, I would code both if it is a Medicare patient.

 

[ReginaR]

I agree also. I bill for a 38221 and a G0364 and do get paid from medicare.