Your CPT Questions

Reprinted from October 1999 CAP TODAY

Clarification

Q: Sometimes we perform a bone marrow biopsy and a bone marrow aspiration together on the same patient on the same day. Medicare is denying the codes. Are we allowed to submit them together?

A: Code 85102 Bone marrow biopsy, needle or trocar and code 85095 Bone marrow; aspiration can be billed together; however, you must use the -59 modifier (Distinct Procedural Service: Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier ‘-59’ is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances) when submitting the two codes to Medicare and some private insurers. Codes 85102 and 85095 are part of the National Correct Coding Initiative (CCI) edits for Part B Medicare carriers. The CCI edit list includes pathology CPT code pairs that are not usually paid to the same physician or laboratory for the same patient on the same day because they are considered to be mutually exclusive services or services that are bundled; however, some edit pairs can be paid by using modifier -59, which indicates that the procedures were appropriate under the circumstances and are separate and distinct from one another.

If an interpretation of the bone marrow aspiration is also performed, then code 85097 Bone marrow; smear interpretation only, with or without differential cell count may be submitted. If a bone marrow biopsy was obtained and subsequently decalcified and interpreted, then code 88305 Bone Marrow, biopsy and code 88311 Decalcification procedure (List separately in addition to code for surgical pathology examination) may be submitted if the procedures are performed. If a reading of the peripheral blood smear is performed, Medicare will allow code 85060 Blood smear, peripheral, interpretation by physician with written report to be submitted for Medicare inpatients only; code 85060 may be submitted for non-Medicare inpatients and outpatients.

Q: Can I use code 88162 in addition to the FNA codes when an aspirate involves the preparation of more than five slides?

A: No, it would be inappropriate to use 88162 Cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains in addition to the FNA codes (88172-88173) for FNA specimens that involve more than five slides. Cytology codes for fluids and FNA were established to represent an average case because some cases have a greater and some a lesser number of slides. Just as one would not expect to “downcode” for a one-slide case, one should also not “upcode” for a case involving a large number of slides.

The 88160 code family should not be used for FNA or gynecological specimens or for nongyn fluids, washings, or brushings. It would be appropriate to use the 88160 family to code the smears from specimens such as sputum, imprints from tissue, or smear from a nipple discharge. FNA codes 88172 and 88173 state, “Evaluation of fine needle aspirate with or without preparation of smears.” This means that any smears (from one to an infinite number) are included when either code 88172 or 88173 is reported.

The codes and descriptions listed here are from Current Procedural Terminology, a copyrighted publication of the American Medical Association. To purchase CPT books, call the AMA at (800) 621-8335.