May 2015 Q & A

Question: Coding Both Bone Marrow Aspiration and Bone Marrow Core Biopsy

According to the AMA’s CPT Assistant March 2015, when both bone marrow aspiration and bone marrow biopsy of the same site are performed, we can code both 38221 and 38220. Since there is a NCCI edit between the two codes, can we use modifier -59 to override this edit? Please clarify. Thanks.


Answer:

We follow Medicare billing and coding guidelines when available. Medicare has specifically addressed the code combination you are asking about. Code G0364 was created by Medicare to use when billing Medicare for the two procedures performed at the same site. Consequently, we do not recommend billing 38220 and 38221 together when performed at the same site for Medicare patients. This was a top ten incorrect use of the -59 modifier a few years back in the OIG work plan. For non-Medicare payers, you should discuss the coding directly with them (especially if they do not recognize G0364).

From the National Correct Coding Initiative Manual for Medicare Services:
“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 date of service.”