Re: Bone Marrow CPT codes

Eileen Dusek at Central Dupage Hospital (wherever that is - and Eileen, 
please turn off HTML in your e-mail client) asks whether there is a CPT code 
(standardized USA billing code) for a tech assisting a pathologist OR a 
clinician in performing a bone marrow aspiration and biopsy.

I'm not aware of such a code. Have you checked the CPT book (published 
annually by AMA - there's a copy locked up in your lab manager's office)? 
This is a CPT question for a coding expert, though most of them don't know 
pathology coding.

A pathologist who delegates CPT coding decisions to a secretary, tech, or 
locum tenens pathologist (that's me) is a damn fool. On the one hand, every 
overcode is a potential felony, with a stretch at Allenwood for the 
responsible party. On the other hand, a disinterested coder will take the 
easy way out and undercode, losing huge amounts of money for the hospital and 
the pathologist. Not many of my locum tenens clients delegate CPT coding to 
me, even though I probably know how to do it better than most of them do.

An ordinary bone marrow aspiration and biopsy gets the following codes, 
though only if the report documents the procedure and justifies the code. 
Since nothing puts the average pathologist into status dictatus (the 
zombie-like mental state induced by stepping on the microphone's foot switch) 
faster than a tray full of bone marrow slides, it's unusual to see a report 
that justifies all the codes. Remember that the Cowboy Way requires 
generation of two separate reports, one for the smears and one for the 
sections, with no reference between them permitted, so if you're coding make 
sure you have both reports available to you.

85060: examination of peripheral smear. Billable, though unlikely to get 
paid. Remember that many pathologists do not even have access to peripheral 
smears, let alone examine or report them.

85097: examination of the marrow smears. This is the code if the pathologist 
didn't do the procedure - if he did it, it's 85095.

88305 x2: billed twice, once for the clot and once for the core biopsy 
specimen. (85102 if the pathologist did the procedure).

88311: decalcifying the core biopsy specimen. Decalcification should be 
documented in the report. "The decalcified needle biopsy specimen shows 
normally cellular marrow...."

88313: iron stain. Can only be billed once, even if you stain both a smear 
and a section, as is good practice.

Obviously there are additional codes for IHC and flow studies and the like.

Bob Richmond
Samurai Pathologist
Knoxville TN

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