Q&A: G0364 add-on code

Wednesday, November 29, 2017

Q: I recently came across an edit from our Medicare Administrative Contractor (MAC) that I've never seen before: G0364 is an add-on code requiring a primary procedure code of 38221. We are having a discussion in our facility whether G0364 should be inclusive of both the bone marrow biopsy and the bone marrow aspiration done through same site, same incision, same date vs. coding G0364 secondary to the 38221, bone marrow biopsy at the same site, same incision, same day. AHA Coding Clinic, 2012 Q3, “Bone Marrow Aspiration” states that G0364 represents the bone marrow aspiration procedure when it is performed with a bone marrow biopsy through the same incision, same date of service and both codes should be reported. I can’t find any guidance from Medicare regarding this edit.  – Is G0364 an add-on code requiring a primary procedure code of 38221?

A: CMS developed “Add-on Code Edits” a few years ago that are not the same as CPT®/HCPCS add-on codes. These are Medicare-specific payment edits that won’t be addressed through coding guidance like CPT Assistant or Coding Clinic for HCPCS. An add-on code describes a service always performed in conjunction with another primary service and it may not be reported unless the code for the primary service is also reported on the same claim.  If a Medicare add-on code is reported without the required primary procedure code, the claim will be returned to the provider for correction.  In the example you provided, G0364 is a Type I add-on code edit where Medicare will not pay for the code separately unless 38221 is also reported on the same claim/DOS. See Medicare Claims Processing Manual, Transmittal 2636, for more information. You can find Type I, Type II, Type III edits by going to the “National Correct Coding Initiative” link under the “Medicare Related Sites – General” section on HCPro’s links page. Use the links on the left navigation to go to “Add-on Code Edits” and download the appropriate Excel file for the DOS.

 

Note: This question can be found in the billing and claims section on the NAHRI Forums where you can find answers to questions on a variety of topics from billing and claims to compliance to reimbursement. This question was answered by Debbie Mackaman, RHIA, CPCO, CCDS, regulatory specialist and lead instructor at HCPro, an H3.Group brand, in Middleton, Massachusetts.

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