Ob-Gyn Coding Alert

Although more and more expectant mothers request that their ob-gyns collect cord blood at the time of delivery, many practices don't know how to code the procedure or if they should code it at all.

Ob-gyns harvest cord blood moments after they deliver a baby. Instead of discarding the umbilical cord, the physician uses a syringe to extract approximately 50 cc of blood. The blood contains stem cells, immature cells that have the potential to develop into other types of cells, such as muscle or bone. Physicians may use these cells to treat patients with leukemia and other conditions as an alternative to bone marrow transplants.

Some physicians might be tempted report the procedure using 38205 (Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogenic) or 38206 ( autologous). The codes were added for 2003 to replace 38231 (Blood-derived peripheral stem cell harvesting for transplantation, per collection).

But these codes describe very long procedures that include returning the harvested blood back into the body, as is typical with apheresis treatments.

The correct code for collecting cord blood is S2140 (Cord blood harvesting for transplantation, allogeneic). Although Blue Cross/Blue Shield created this code, CMS has included it in the national code set.

Alternatively, you could use 59899 (Unlisted procedure, maternity care and delivery). Because this is an unlisted-procedure code, you should include the operative note when submitting it to give the payer a clear picture of the procedure the ob-gyn performed.

Keep in mind that many carriers will not reimburse for this because it is an elective procedure requested by the patient.

In fact, some coding experts maintain that you shouldn't separately report collecting cord blood at delivery. This is a minor procedure that is done at no cost to the physician, according to Philip Eskew, MD, medical director of women and infants' services at St. Vincent's Hospital's Family Life Center in Indianapolis, and Grace Kotowicz, a member of the AMA's CPT editorial staff, both speaking during the recent AMA CPT Symposium in Chicago. The American College of Obstetricians and Gynecologists' (ACOG) coding committee agrees with the AMA.

Despite the AMA and ACOG's advice, some ob-gyns maintain that you can separately code for cord blood collection at delivery. "We do charge for this procedure [previously with 38231], and most insurance companies do cover this," says Edwin Radke, MD, a practicing ob-gyn at Andover Ob-Gyn in Andover, Mass. If the carrier doesn't cover the cord blood collection, Radke's practice informs the patient beforehand and charges her the fee. "After all, it is a voluntary and completely elective procedure," he says.

"Do not forget that this is a procedure involving not only time but also needles and quite a bit of blood," Radke argues. Although cord blood collection is a fairly straightforward procedure, "so are a lot of the things we routinely do and charge for."

Nonetheless, Radke's practice communicates with the patient's insurance carrier before the delivery to ensure that it will accept 38231 in 2002 and 38205/38206 in 2003 for cord blood collection. If the payer denies the approval, the practice has the patient pay ahead of time, Radke points out.