Ob-Gyn Coding Alert

Question: Can you offer some insight into coding for the physicians service of cord blood collection post-delivery? This is a new procedure that is being done infrequently and we have never billed for it. We expect it will be performed more often in the future and there is no CPT code established. However, we think these codes most closely resemble the service provided: 38231-26 linked to V59.09 or 85999 linked to V59.02. Is this correct? Are there more suitable codes and how are other practices billing for this service?

Collen Rusoff
Brielle Ob/Gyn, Lakewood, NJ

Answer: The CPT codes suggested here for cord blood collection, 38231-26 and 85999, are incorrect. Code 38231 is used to report harvesting bone marrow or stem cells, not cord blood. Also, a modifier -26 would not be used with this procedure, because this modifier is only used to indicate the professional component of a procedure (i.e., interpretation and report) when the services also have a technical component that is being billed separately by a different provider. Also, code 85999 is an unlisted procedure code that would be reported by the laboratory, not the physician.

Collection of cord blood is similar to the collection, processing and storage of an autologous blood or component, which is predeposited for later use. This service is described by the laboratory code 86890. However, this is a laboratory code that is subject to CLIA regulations and would not be reported by the physician who collects the cord blood. Instead, the CPT instructs the use of E/M code 99201-99204. Notice that these are new patient E/M services. It might be arguable whether the fetus is a new patient to the obstetrician or an established patient, but logic would say that this was an established patient service performed in an inpatient setting.

The bottom line is, use an inpatient hospital code for this service and add a modifier -24 to indicate that the service was not related to the delivery or pregnancy. The diagnoses V59.09 and V59.02 would not be correct because they do not state why the cord blood collection was medically necessary in this case. You will need to find out what family history is and code for that.

Finally, doing all of this does not necessarily make the services covered and payable by the insurance company. Do not submit this claim to the insurer unless you know in advance that they will pay for this service. If the carrier inadvertently pays because of the way you coded it, you might be accused of fraud.