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Oncology & Hematology Coding Alert

3 Strategies Help You Improve Coding for Stem Cells

Published on Sat Oct 18, 2003

We'll show you how to recoup stem-cell transplantation pay

When oncologists perform stem-cell procedures, you'll need to know how to code three basic services: harvesting, storage and transplanting.
 
Before you begin choosing stem-cell procedure codes, make sure you know the recent CPT and Medicare changes regarding cell transplantation. In 2003, CPT introduced 12 new stem-cell-related codes (38204-38215), which represent harvesting and transplantation procedures for bone marrow and stem cells. CMS, however, considers codes 38207-38215 invalid for Medicare purposes, says Linda L. Lively, MHA, CCS-P, RCC, CHBME, president and chief executive officer of AMAC, a coding consultant firm in Atlanta. 
 
To help you fine-tune your stem-cell reporting, follow these three tips offered by our coding experts.

1. Pick Harvesting Codes Based on Removal Site

You'll need to know the specific stem-cell harvest site to code this procedure accurately.The oncologist may harvest stem cells from bone marrow, blood or a self-donor to treat diseases such as leukemia (204.xx) and nodular lymphoma (202.0x), says Cindy Parman, CPC, CPC-H, RCC, principal and co-founder of Coding Strategies in Powder Springs, Ga.
 
When the oncologist harvests cells from bone marrow, report 38230 (Bone marrow harvesting for transplantation). Typically, the physician removes the marrow with a biopsy needle that he or she inserts into the iliac crest. Make sure you don't report 38220 (Bone marrow; aspiration only) or 38221 (... biopsy, needle or trocar) for the harvesting procedure - 38220 and 38221 represent diagnostic bone-marrow sampling.
 
To abstract stem cells through a patient's blood, oncologists use a process called cytapheresis. This procedure involves collecting blood, separating the stem cells, and immediately returning the leftover cells to the patient.
 
You should report each cytapheresis session separately using 38205 (Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic) and 38206 (... autologous). In 2003, The National Correct Coding Initiative, version 9.0, made 38205, 38206 and 38230 mutually exclusive, meaning that you can't bill these codes together on the same day. Also, you can't unbundle the codes with a modifier, Lively says.
 
This makes sense, because an oncologist probably won't harvest stem cells for the same patient on the same day using both bone marrow and blood sources.
 
Don't confuse cytapheresis with an apheresis procedure, such as 36511 (Therapeutic apheresis; for white blood cells). Oncologists use apheresis to extract a patient's blood and remove certain factors, such as red blood cells (36512) or platelets (36513). The apheresis equipment then returns the remaining blood to the patient, Parman says.

2. Code All Cell Processing and Storage Steps

Whether you're reporting services to Medicare or a private carrier will determine the codes you use for  therapeutic processing and stem-cell storage billing.
 
For example, if your oncologist stores a Medicare patient's stem cells after harvesting them, you can safely report 38205 (... cell harvesting ...) to both a private payer and Medicare.
 
But CMS requires a HCPCS Level II code for the storage services. Most private payers accept CPT's 38207 (Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage).
 
On the other hand, Medicare carriers, such as FIRST COAST Service Options (FCSO), in Jacksonville, Fla., will accept only G0265 (Cryopreservation, freezing and storage of cells for therapeutic use, each cell line) for storing stem cells. Medicare also requires different codes that represent stem-cell thawing and expansion. For instance, suppose your oncologist plans to transplant a lymphoid leukemia (204.0x) patient's stem cells after extensive chemotherapy treatments (96400-96549). The physician washes and thaws harvested stem cells, and then depletes the harvest's T-cell count prior to transplantation. If a private insurer covers the patient, you would report the physician's work as follows:

  • 38210 - ... specific cell depletion within harvest,  T-cell depletion
  • 38208 - ... thawing of previously frozen harvest
  • 38209 - ... washing of harvest.

    On the other hand, if Medicare insures the patient, you should assign the following codes for the depletion, thawing and washing services:

  • G0267 - Bone marrow or peripheral stem cell harvest, modification or treatment to eliminate cell type(s) (e.g., T-cells, metastatic carcinoma). Report this code instead of 38210.
  • G0266 - Thawing and expansion of frozen cells for therapeutic use, each aliquot. Choose this code instead of 38208 when billing Medicare.

    CMS doesn't pay separately for cell washing, and includes this procedure with other stem-cell services, Parman says.
     
    Private insurers will pay for 88240 (Cryopreservation, freezing and storage of cells, each cell line) and 88241 (Thawing and expansion of frozen cells, each aliquot) for oncologists' diagnostic processing and storage services. Medicare considers 88240 bundled into G0265 (Cryopreservation ...), as well as 88241 into G0266 (Thawing ...), Parman says.
     
    Also, remember that you should report 88240-88241 for procedures performed in a clinical laboratory setting, Lively says.

    3. Use Infusion Type to Determine Transplant Code

    Make sure you read the oncologist's documentation carefully when reporting stem-cell transplants. The physician should note whether he or she performed an allogenic or autologous transplant.
     
    In autologous transplantation, the oncologist takes cells from the patient's body, such as from marrow or blood, and reintroduces the cells to the patient following intensive chemotherapy. For this service, report 38241 (Bone marrow or blood-derived peripheral stem cell transplantation; autologous).
     
    When the physician performs an allogenic transplant, he or she removes cells from one patient, such as a bone marrow donor, and transplants the cells into a cancer patient. In that case, use 38240 (Bone marrow or blood-derived peripheral stem cell transplantation; allogenic).
     
    If your oncologist treated a Medicare patient, you can't submit 38204 (Management of recipient hematopoietic progenitor cell donor search and cell acquisition) to charge for your physician's management of the stem-cell transplantation donor.

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