Oncology Coding Article – Outpatient Prospective Payment System (OPPS)


Medical Oncology Code Changes

Bone Marrow Biopsy & Aspiration

There is still some confusion regarding reporting the new Medicare add-on code for bone marrow aspiration with a biopsy performed in the same anatomic site. Following is a coding job aid to assist with coding decisions.

1)       Bone marrow aspiration (sole service provided) = 38220
2)       Bone marrow biopsy (sole service provided) = 38221

Bone marrow biopsy and aspiration:            Same patient, and            Same session            Assign codes 38221 (biopsy) & G0364 (add-on code for aspiration)


       Bone marrow biopsy and aspiration:            Different anatomic site (non-contiguous structures), or            Different patient encounters (same date of service)            Assign codes 38221 (biopsy) & 38220-59 (aspiration,

           separate site/session)

There is no change to the code assignment for bone marrow biopsy and aspiration in 2005, with the exception of situations where both services are performed during the same patient encounter in the same (or contiguous) structures.

Medicare indicated in the Part B Final Rule that they believe the performance of both procedures during the same session requires a small additional payment, which equates to approximately $9.85 in the office or freestanding center and about $11.78 under the Outpatient Prospective Payment System (OPPS).

Watch for more 2005 coding changes in the upcoming months.  Review previous Coding and Reimbursement Updates from the Academy’s Website.

This Coding and Reimbursement Update was prepared by:
Cindy C. Parman, CPC, CPC-H
Coding Strategies, Inc.

Phone: (877) 6CODING

Fax: (770) 445-0407

[email protected]

Cindy C. Parman, CPC, CPC-Hcparman-9857600
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association.  She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.