# Platlet rich gel injection.



## jdemar (Apr 30, 2008)

One of my Drs is taking the patient to the OR to *inject platlet rich gel* into the Achilles Tendon.....does anyone have any knowledge of this procedure???   :


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## amitjoshi4 (May 5, 2008)

*Platelet rich gel injection*

See this guideline:


“If physician draws patient's blood intraoperatively, uses special equipment in the OR to centrifuge into separate elements, isolation of the required component (red cells *or* platelets), and finally injecting the desired component into the operative site. With all this being well documented in a report, this would be captured with CPT code 86999*.”

I have been coding these procedures for quite a long time now .

Thank You


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## jdemar (May 6, 2008)

Thank you both for your help, I am checking w my Dr. to see if the 86999 is correct, not sure if he is spinning the blood in the OR or the blood bank @ the hospital is taking care of that portion....thanks again


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## madelin (Jun 2, 2008)

Can I use 20926 for the Autologous platelet gel injection? Medicare is paying for it. Thanks
Madelin


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## sgoodknight (Jun 3, 2008)

20926 is the code that we use and we have been doing this for over a year.  We are using the GPS from Biomet?  Is this the same product you are using?


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## mdevereaux (Jun 3, 2008)

The code I was told to use by the rep is 
36513: therapeutic apheresis;for platelets.

Apheresis: Medicine/Medical. the withdrawal of whole blood from the body, separation of one or more components, and return by transfusion of remaining blood to the donor

Mollie


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## mbort (Jun 4, 2008)

amitjoshi4 said:


> See this guideline:
> 
> 
> “If physician draws patient's blood intraoperatively, uses special equipment in the OR to centrifuge into separate elements, isolation of the required component (red cells *or* platelets), and finally injecting the desired component into the operative site. With all this being well documented in a report, this would be captured with CPT code 86999*.”
> ...




Where did this guideline come from?


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## amitjoshi4 (Jun 5, 2008)

Hi,

This is the Q&A published in CPT Assistant "November 2005, Volume 15,Issue 11,Page 14"

Hope this benefits all.

Thank You


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## mbort (Jun 5, 2008)

Since that CPT asst is from 2005, I think I will stick with Mollie.  I also use the 36513.  The lay description (which I have posted below) better describes what is performed.


36513
Therapeutic apheresis is the removal of some specific circulating blood component, cells or plasma solute, that is directly responsible for a disease process. Cells and plasma components may also be mobilized from other tissue storage during apheresis, such the from the spleen and lymph nodes, for enhanced clearance of the undesired element. The patient is prepared much the same as giving a regular blood donation. Whole blood is drawn out of one arm and into an instrument called a separator, which uses a microprocessing technique to draw the blood, anticoagulate it, and separate the component to be removed by centrifugal spinning, filtration, or column adsorption with the help of computerized calibration. The cells to be removed are collected while the remainder of the blood is recombined and returned to the patient through a tube and needle in the other arm. Report 36511 for white blood cell isolation and removal (leukapheresis or lymphocytapheresis), 36512 for red blood cell removal, and 36513 for removal of platelets.


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## judithdoss (Jun 11, 2008)

*Platelet rich gel injection*

We also are doing the GPS, and have been billing for the injection(20550) and the graft(20926). However, in the April 2008 Ortho Pink Sheet it states that "there is no appropriate physician code to report". You may report 86999 if "you own or lease you own laboratory".  I also listened to a audio conference on 6/10/08 given by Destiny Health( Margie Vaught) who states you can bill for the injection with a modifier 22 for the extra work. Hope this helps!

Judy


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## margiev6 (Jun 25, 2008)

*platelet rich injections*

Below is the National Policy and there are many many LCDs with this also:

270.3 - Blood-Derived Products for Chronic Non-Healing Wounds - (Various Effective Dates Below) 

(Rev. 83, Issued: 05-02-08, Effective: 03-19-08, Implementation: 06-02-08) 

A. General 

Wound healing is a dynamic, interactive process that involves multiple cells and proteins. There are three progressive stages of normal wound healing, and the typical wound healing duration is about 4 weeks. While cutaneous wounds are a disruption of the normal, anatomic structure and function of the skin, subcutaneous wounds involve tissue below the skin's surface. Wounds are categorized as either acute, in where the normal wound healing stages are not yet completed but it is presumed they will be, resulting in orderly and timely wound repair, or chronic, in where a wound has failed to progress through the normal wound healing stages and repair itself within a sufficient time period. 



Platelet-rich plasma (PRP) is produced in an autologous or homologous manner. Autologous PRP is comprised of blood from the patient who will ultimately receive the PRP. Alternatively, homologous PRP is derived from blood from multiple donors. 



Blood is donated by the patient and centrifuged to produce an autologous gel for treatment of chronic, non-healing cutaneous wounds that persists for 30 days or longer and fail to properly complete the healing process. Autologous blood derived products for chronic, non-healing wounds includes both: (1) platelet derived growth factor (PDGF) products (such as Procuren), and (2) PRP. 



The PRP is different from previous products in that it contains whole cells including white cells, red cells, plasma, platelets, fibrinogen, stem cells, macrophages, and fibroblasts. 



The PRP is used by physicians in clinical settings in treating chronic, non-healing wounds, open, cutaneous wounds, soft tissue, and bone. Alternatively, PDGF does not contain cells and was previously marketed as a product to be used by patients at home. 

B. Nationally Covered Indications 

Not applicable. 

C. Nationally Non-Covered Indications 



1. Effective December 28, 1992, the Centers for Medicare & Medicaid Services (CMS) issued a national non-coverage determination for platelet-derived wound-healing formulas intended to treat patients with chronic, non-healing wounds. This decision was based on a lack of sufficient published data to determine safety and efficacy, and a public health service technology assessment. 



2. Effective July 23, 2004, upon reconsideration, the clinical effectiveness of autologous PDGF products continues to not be adequately proven in scientific literature. As the evidence is insufficient to conclude that autologous PDGF in a platelet-poor plasma is reasonable and necessary, it remains non-covered for treatment of chronic, non-healing cutaneous wounds. Also, the clinical evidence does not support a benefit in the application of autologous PRP for the treatment of chronic, non-healing, cutaneous wounds. Therefore, CMS determines it is not reasonable and necessary and is nationally non-covered. 



3. Effective April 27, 2006, coverage for treatments utilizing becaplermin, a non-autologous growth factor for chronic, non-healing subcutaneous wounds, remains nationally non-covered under Part B based on section 1861(s)(2)(A) and (B) of the Social Security Act because this product is usually administered by the patient. 



4. Effective March 19, 2008, upon reconsideration, the evidence is not adequate to conclude that autologous PRP is reasonable and necessary and remains non-covered for the treatment of chronic non-healing, cutaneous wounds. Additionally, upon reconsideration, the evidence is not adequate to conclude that autologous PRP is reasonable and necessary for the treatment of acute surgical wounds when the autologous PRP is applied directly to the closed incision, or for dehiscent wounds. 



D. Other 

In accordance with section 310.1 of the National Coverage Determinations Manual, the routine costs in Federally sponsored or approved clinical trials assessing the efficacy of autologous PRP in treating chronic, non-healing cutaneous wounds are covered by Medicare. 

(This NCD last reviewed March 2008.) 



CPT Adds their comments on PRP



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 PLATELETs 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." 

Margie Scalley Vaught, CPC, CPC-H, CCS-P, MCS-P, ACS-EM, ACS-OR
Healthcare Consultant
Coding Content Specialist for DecisionHealth
scalley123@aol.com
cell 360-880-8304 
fax 413-674-7668
www.margievaught.com
for workshops and audio http://www.margievaught.com/calendar/index.cfm


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