Oncology & Hematology Coding Alert

Coding Quiz Answers:

Check Your Answers to Our Stem Cell Harvesting Coding Quiz

Published on Tue Aug 24, 2021

Here’s all you need to know about donor review, stem cell harvesting, and storage.

Once you’ve answered the quiz questions on page 3, compare your answers with the ones provided below:

Answer 1: Before performing a stem cell transplant on a patient, your provider should assemble a team to review records and screen potential donors for bone marrow or stem cell compatibility with the patient. When the team eventually finds a potential donor, your provider will take samples from the potential donor and assess them; if the donor proves to be compatible, your provider will then make a plan to harvest cells from the donor.

Once your provider and team have accomplished this, you can go ahead and use 38204 (Management of recipient hematopoietic progenitor cell donor search and cell acquisition) to document the service.

Answer 2: The two codes you can use to document a stem cell harvest from a donor’s bone marrow — 38230 (Bone marrow harvesting for transplantation; allogeneic) and 38232 (Bone marrow harvesting for transplantation; autologous) — do not specifically reference a syngeneic stem cell transplant, which is a transplant from an identical twin. But knowing that an autologous harvest uses stem cells that come from the patient while an allogeneic harvest uses cells that come from someone other than the patient should lead you to use 38232 in encounters where the stem cells come from bone marrow from blood relatives, which would obviously include an identical twin.

Remember: As the bone marrow sampling is for therapeutic and not diagnostic purposes, never report 38220 (Diagnostic bone marrow; aspiration(s)) or 38221 (Diagnostic bone marrow; biopsy(ies)) when describing this procedure.

Answer 3: To document stem cell harvesting from a donor’s blood using an apheresis device, you might be tempted to use one of the 36511-36516 (Therapeutic apheresis …) codes. These codes describe procedures where a physician removes whole blood from a patient, separates it into constituent parts (plasma, leukocytes, platelets, or cells), and re-transfuses the blood constituent, along with another fluid to maintain volume, back into the same patient’s body.

But 36511 (Therapeutic apheresis; for white blood cells) should not be confused with 38205 (Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic) or 38206 (Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous) as “the typical patient for 36511 has high white blood cell or leukemic blast counts with an unacceptably high risk of cerebral or pulmonary leukostasis, a potentially fatal condition that results from obstruction of small arteries or arterioles by adherent white blood cells” according to CPT^® Assistant (October 2013; Volume 23: Issue 10).

CPT^® codes 38205 and 38206, however, “are used to report the actual harvesting of cells for transplantation using an apheresis device,” the CPT^® Assistant article continues. So, while 36511-36516 are used to describe procedures where blood constituents are separated from, then transfused back into, the same patient, 38205 and 38206 represent harvest of stem cells from a donor’s blood, which would be the correct codes to use in this encounter. And as you need a code that describes an allogenic rather than an autologous harvest, 38205 is the correct code to use.

Answer 4: For these services, you’ll use the appropriate code from 38207-38209 (Transplant preparation of hematopoietic progenitor cells …), specifying 38207 for cryopreservation and storage, 38208 for thawing of a previously frozen harvest, without washing, per donor, and 38209 for thawing and washing, per donor.

Like the bone marrow harvesting codes 38230 and 38232, codes 38207-38209 must be used specifically in situations where the hematopoietic cells are being used for therapeutic purposes. Cryopreservation, storage, and thawing for diagnostic purposes is coded with 88240 (Cryopreservation, freezing and storage of cells, each cell line) and 88241 (Thawing and expansion of frozen cells, each aliquot).

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