Oncology & Hematology Coding Alert

To ensure complete reimbursement for stem cell treatments, oncology coders should familiarize themselves with the various steps of stem cell harvesting, storage, and transplantation to distinguish between narrowly defined coding options. They can benefit from knowing the roles that other specialists, such as pathologists and hematologists, play in the process. Myrlena Lee, patient account supervisor for transplant programs at St. Luke's Hospital in Kansas City, Mo., says the physicians and nurse practitioners on the team should be advised how to work with coders because "you can code and bill all you want, but if you're not documenting and getting prior authorizations up front, it's not going to do any good." Preparation Most oncology clinics choose peripheral stem cell transplants over bone marrow transplants, says Beth Harvey, RN, transplant coordinator for the Kansas City Blood and Marrow Transplant Program in Kansas City, Mo. Peripheral, or blood-derived, transplantation is more common with autologous procedures in which a patient receives his or her own stem cells; however, the oncologist may also collect by bone marrow if the peripheral blood collection is not adequate.

"We specialize in autologous peripheral stem cell transplantation because of the ease of collection, faster recovery and long-term disease benefits," says Dipnarine Maharaj, MD, director of the Bone Marrow Stem Cell Transplant Institute at Bethesda in Boynton Beach, Fla., and a fellow of the Royal College of Pathologists of the United Kingdom.

"The patient's oncologist and transplant physician (often a hematologist) will coordinate care carefully while the patient receives chemotherapy," Maharaj says. "The patient typically has an intravenous catheter placed codes 36488-36533, depending on circumstances such as which vein is used and the patient's age to facilitate the frequent blood analyses and treatment procedures that will be taking place."

In some cases, chemotherapy is done for mobilization of the stem cells along with administration of a growth factor, while other mobilizations are done with growth factors alone, Harvey says. Often patients will receive "salvage" chemotherapy in an effort to put them in a minimal disease state prior to mobilization and transplant. Harvey says the typical regimen for mobilization at her clinic is Cytoxan (J9091-J9095) for one day, then administration of a daily growth factor until the cells are collected. Harvesting Before stem cell collection, the patient will receive stem cell growth-stimulating factors, through either the catheter (if one is present); an IV push, 90784 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; intravenous); or subcutaneous injection, 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular).

It is correct to code separately the administration of the growth factors with 90784 or 90782 depending on the administration route. Many Medicare carriers, however, define this process as "stem cell infusion" [...]