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Report 38221-50 for bilateral bone marrow biopsy

APCs Weekly Monitor, December 1, 2006

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Report 38221-50 for bilateral bone marrow biopsy

QUESTION: If a physician performs a bone marrow biopsy bilaterally (on the right and left iliac crest), how should we code and charge this service? I am having trouble finding specific guidelines concerning how to code this procedure. Would I report 38221 (Bone marrow biopsy, needle or trocar) with modifier -50, to indicate that the physician performed it bilaterally? And should we charge the procedure twice?

ANSWER: The Medicare Physician Fee Schedule (MPFS) houses a "bilateral column" which CMS uses to determine the bilateral edits under the OPPS (OCE edits 16 and 17). It would be appropriate to report 38221-50 for a bone marrow biopsy performed on the right and left iliac crest. This will trigger APC 0003, status indicator (SI) T, with a national unadjusted payment of $159.23.

Reporting modifier -50 and a SI of T will discount this procedure: You will be paid 100% for the right side and 50% for the left side, for a total of $238.84 national unadjusted payment.

Note: Review G0364 (bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) as you examine your medical record documentation for these types of procedures. You may report this code in addition to 38221 in some circumstances.

You can find the MPFS at the CMS Web site: http://www.cms.hhs.gov/PhysicianFeeSched/.

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