# Plasma rich injections not during surgery - My Ortho docs



## Lisa Bledsoe (Oct 15, 2009)

Hi All - My Ortho docs are going to start doing these injections in the office.  They are purchasing syringe kits and the vendor is "giving" them a centrifuge.  The nurse will draw the blood and spin it; then the doc will inject (ie tendons, etc).  So my question:  is anyone else doing this specifically and if so, what are you coding?  I have read the other posts but am not finding the answer I am looking for...of course, maybe that answer does not yet exist...


----------



## kjstearns (Oct 15, 2009)

Our office has begun doing these as well. We are charging for the injection code, 20600-20610 or 20550-20551, as well as the blood draw (36415). There has been some debate over whether or not we should be charging for the blood draw, so just keep that in mind. We have been getting paid on it though. We are also charging J3590, unclassified biologics code for the kit and writing "Platelet Rich Plasma" in box 19 on the claims. 
Hope this helps!

~Kirsten


----------



## RebeccaWoodward* (Oct 15, 2009)

A few years back we started to do this...stopped...and now performing these again.  I had to do some research to see if anything has changed from "way back when".  This is what Margie's states...

The CPT Advisors also specifically clarified the use of CPT codes when the platelet cells in plasma injection is performed independent of another definitive surgical procedure: "If injection of the platelet rich cells is performed into a joint (independent of a concurrent definitive surgical procedure), then code *20600, 20605 or 20610 *is reportable. If injecting into a tendon, then *20550* is appropriate and if into a tendon origin/insertion then *20551* regardless of the anatomic site involved. 


According to the CPT Advisors representing the College of American Pathologists and the American Society for Clinical Pathology, code *86999* Unlisted transfusion medicine procedure, should be reported when for example, intraoperatively, 60 ccs of blood is drawn from the patient, centrifuged for 15 minutes to separate the platelet rich [fibrin] from platelet poor plasma and red cells and injected into the operative site.

http://www.margievaught.com/index.cfm?fuseaction=event&mode=1&eventID=89

I would like to know if this is what others are doing, too~


----------



## mbort (Oct 15, 2009)

kjstearns said:


> Our office has begun doing these as well. We are charging for the injection code, 20600-20610 or 20550-20551, as well as the blood draw (36415). There has been some debate over whether or not we should be charging for the blood draw, so just keep that in mind. We have been getting paid on it though. We are also charging J3590, unclassified biologics code for the kit and writing "Platelet Rich Plasma" in box 19 on the claims.
> Hope this helps!
> 
> ~Kirsten



I'm a little confused on how you are justifying using J3590 for the "supply" kit?

Keep in mind that "getting paid for it" doesn't make it correct.  There is a ton of new information from the AMA on the website that Rebecca has provided above from just a few months ago that you want to review.


----------



## aprilroc (Oct 15, 2009)

I have doctors that are doing this also, we do these in the hospital setting, ie: procedure room or outpatient setting. We are only billing 86999, we submit this with documentation and have had no problems so far. I was told using a joint injection code was not appropriate.


----------



## RebeccaWoodward* (Oct 15, 2009)

*"I was told using a joint injection code was not appropriate. "*

Why? and by whom?...Out of curiosity....


----------



## BFAITHFUL (Oct 20, 2009)

Our doctor does these PRP injections along with a percutaneous tenotomy since I was getting all kinds of different information , I decided to send an inquiry to the American Medical Association and their response was NOT to use the tenotomy code because it wasn't considered a true tenotomy it was just puncture wounds in order for it to receive the PRP and to only use CPT 86999.  They also stated they are trying to come with a category III code that would represent everything from obtaining the PRP to the injection into the site.            So we're being conservative and just billing the 86999


----------



## BFAITHFUL (Oct 20, 2009)

Below is part of the article that's posted on Margie's website



*My question was*: 
"PLATELET RICH plasma injections performed in the office for patients with muscle tears, meniscus tears, tendonitis and possibly other conditions and the only thing done, how should these be coded? Manufacturers are stating 20926 with 20550-20552 or 20610, and with 36513 or 36514 or 38230, and venipuncture, and with 86499 or 86940. 

*Reply:* 
...from a CPT coding perspective, whether performed in conjunction with a definitive surgical procedure or injected as indicated in your inquiry, there is no specific CPT code to describe PLATELET RICH plasma injection from the patient's blood, having been drawn and centrifuged, and injected into the anatomic site involved. 
It would not be appropriate to report codes 20926, 20552, 20610 or codes 36513 or 36514 or 38230 to describe PLATELET RICH plasma injection from the patient's blood, having been drawn and centrifuged, and injected into the anatomic site involved. It is not appropriate to report code 86985 Splitting of blood or blood products, each unit to describe the derivation of the PLATELETs. Therefore, it is not appropriate to report code 86940. 
According to the CPT Advisors representing the College of American Pathologists and the American Society for Clinical Pathology, code 86999 Unlisted transfusion medicine procedure, should be reported when for example, intraoperatively, 60 ccs of blood is drawn from the patient, centrifuged for 15 minutes to separate the PLATELET RICH [fibrin] from PLATELET poor plasma and red cells and injected into the operative site. "
In fact CPT and ICD-9 Coding Clinic have both stated that when performed during a surgical procedure there is NO additional professional service to report. However sales reps are giving these codes out inappropriately. Blood is not a (20926) paratendon, is not fat, is not dermis and is not a tissue graft - it is blood.


----------



## Lisa Bledsoe (Oct 20, 2009)

A category III code would be nice, but a true CPT would be even better!  They would need to differentiate between PRP at the time of a surgical procedure and PRP done in the office as an injection only.


----------



## astephens (Oct 20, 2009)

I attended a seminar recently and i was told to follow this:
CPT® Assistant November 2005 Volume 15 issue 11 
"Question: During an orthopedic procedure, 60 cc of the patient's blood was drawn and then centrifuged for 15 minutes to separate the *PLATELET*-*RICH* PLASMA from the *PLATELET*-poor PLASMA. The red cells were injected into the operative site. What are the appropriate CPT codes to report for these procedures? 

AMA Comment: The instillation of the *PLATELET*s by the surgeon into the surgical site would not warrant additional CPT code reporting as this is considered an integral part of the total procedure performed; therefore, the instillation is not separately reportable as there is no significant, additional physician work involved. However, code 86999, Unlisted transfusion medicine procedure, should be reported when blood is drawn intraoperatively from the patient and centrifuged to separate the *PLATELET*-*RICH* from *PLATELET*-poor PLASMA and the red cells are injected into the operative site."


----------



## aprilroc (Oct 27, 2009)

I also used information from the article on Margie Vaught's site and discussion with a rep who my Dr was dealing with. We only bill 86999.


----------



## margiev6 (Nov 6, 2009)

The post that is being cut and pasted is an out-dated post - AMA changed their information as of May 18th 2009 - anything prior to this date may not be appropriate anymore. Intraoperatively there is NO additional reporting for injecting PRP into the surgical site/field.  Per the AMA and AAOS intraoperative injections are injections are included.

Updated May 21st, 2009:
I just got a reply this morning (5/21/09) from the AMA and here it is (As of 5/21/09....): 

"May 18, 2009 represents consensus reporting according to our CPT Advisors representing the American Academy of Orthopaedic Surgeons, American Orthopaedic Association and the American Orthopaedic Foot and Ankle Society as of May 14 and May 18, 2009. At that time, the orthopaedic CPT advisors clarified two aspects of this issue: 1) the injection of the platelet rich cells at the time of a definitive surgical procedure; and 2) when this injection is performed into a tendon or joint independent of another surgical procedure. 

The CPT Advisors indicated that "the American Academy of Orthopaedic Surgeons Global Service Data book specifically states in # 1 that local infiltration of most agents in included in the surgical procedure performed. Injecting plasma is not any different." 

The CPT Advisors also specifically clarified the use of CPT codes when the platelet cells in plasma injection is* performed independent of another definitive surgical procedure*: "If injection of the platelet rich cells is performed into a joint (independent of a concurrent definitive surgical procedure), then code 20600, 20605 or 20610 is reportable. If injecting into a tendon, then 20550 is appropriate and if into a tendon origin/insertion then 20551 regardless of the anatomic site involved. 
*the platelet rich cell injection is not reportable either using code 24357 Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); percutaneous, nor should code 20550 be reported in addition to 24357 when a "tenotomy" of the elbow is performed. It would not be appropriate to report code 24357 to describe the injection of platelet rich cells into a tendon*. 

ICD-9 Coding Clinic, Vol 19 No 2, 2nd Qtr 2002 
"Question: 
Our surgeons are now using PLASMA RICH PLATELETs to augment bone graft procedures. During the surgical procedure, a small sample (approximately 100 cc) of the patient's blood is drawn and placed into a disposable blood chamber(s) for processing in the Symphony PLATELET Concentrate System centrifuge. In the process, PLATELET poor PLASMA volume is removed from the blood samples. Approximately 10 ml of PLATELET RICH PLASMA (PRP) is procured. The surgeon conjugates the PLATELET concentrate with bone graft material and then applies the material to the wound site prior to closure. How should the procuring and application of the PRP via the automated processing system be coded or would this be considered a component of the bone graft procedure? 

Answer: 
Do not assign a unique code for the procuring or the application of the PLASMA RICH PLATELETs, since the use of the PLASMA is considered an integral part of the total procedure."


----------



## RebeccaWoodward* (Nov 6, 2009)

_The CPT Advisors also specifically clarified the use of CPT codes when the platelet cells in plasma injection is performed independent of another definitive surgical procedure: "If injection of the platelet rich cells is performed into a joint (independent of a concurrent definitive surgical procedure), then code 20600, 20605 or 20610 is reportable. If injecting into a tendon, then 20550 is appropriate and if into a tendon origin/insertion then 20551 regardless of the anatomic site involved_

For clarification...20600, 20605, 20610, 20550, or 20551 would be the ONLY procedure involved...no other procedures.  Is it safe to say that one of the procedures above could be billed in addition to 86999?


----------



## kjstearns (Nov 6, 2009)

I'm curious- the rep we use gave us the code 99070 to use for the kit. Is anybody using this? Or should we be going with the unlisted, 86999??


----------

