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Pathology/Lab Coding Alert

You Be the Coder:

Omitting G0364 Could Stall Aspiration Pay

Question: When our pathologist performs a bone marrow aspiration and biopsy for a Medicare patient, we bill 38221 and 38220-59 since Correct Coding Initiative (CCI) edits indicate that we can override the edit pair. Were still getting denials -- do you have any advice? Maryland Subscriber Answer: Coding edits might allow you to bill 38220 (Bone marrow; aspiration only) with 38221 (& biopsy, needle or trocar), but thats not your best tactic. If your pathologist completes a bone marrow aspiration and biopsy during the same encounter (and uses the same incision for both procedures), report 38221 for the biopsy, but change your aspiration code. Instead of 38220, report G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service). HCPCS 2009 highlights G0364 as a carrier discretion code. Contact your carrier for specific coverage guidelines before submitting your claim. Remember that commercial and [...]

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