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Oncology & Hematology Coding Alert

Reader Question:

Blood Component Drives Apheresis Claims

Published on Mon Nov 15, 2004

Question: Our physician recently began performing apheresis on patients, and we want to make sure our coding is correct for the procedures. What code group should we use for reporting apheresis, and what are some indicators of the condition?

Nevada Subscriber
 
Answer: Apheresis (also known as pheresis or therapeutic pheresis) is a medical procedure in which the physician removes selected blood constituents (plasma, leukocytes, platelets, or cells) from whole blood, according to the Medicare Coverage Issues Manual. The remainder is retransfused into the person from whom the blood was taken.

When reporting apheresis, choose from the following six codes:

  • 36511 - Therapeutic apheresis; for white blood cells

     36512 - ... for red blood cells

  • 36513 - ... for platelets

  • 36514 - ... for plasma pheresis
  • 36515 - ... with extracorporeal immunoadsorption and plasma reinfusion

  • 36516 - ... with extracorporeal selective adsorption or selective filtration and plasma reinfusion.

    This is a list of some of the indications covered for apheresis, according to the Medicare manual:

  • Plasma exchange for acquired myasthenia gravis

  • Leukapheresis in the treatment of leukemia

  • Plasmapheresis to treat primary macroglobulinemia (Waldenstrom)

  • Treatment of hyperglobulinemias, including (but not limited to) multiple myelomas

  • Cryoglobulinemia and hyperviscosity syndromes

  • Plasmapheresis or plasma exchange as a last-resort treatment of thrombotic thrombocytopenic purpura (TTP)

  • Plasmapheresis or plasma exchange in the last-resort treatment of life-threatening rheumatoid vasculitis

  • Plasma perfusion of charcoal filters for treatment of pruritis of cholestatic liver disease

  • Plasma exchange in the treatment of Goodpasture's syndrome

  • Plasma exchange in the treatment of glomerulonephritis associated with
    antiglomerular basement membrane antibodies and advancing renal failure or
    pulmonary hemorrhage

  • Treatment of chronic relapsing polyneuropathy for patients with severe or life-threatening symptoms who have failed to respond to conventional therapy

  • Treatment of life-threatening scleroderma and polymyositis when the patient is unresponsive to conventional therapy

  • Treatment of Guillain-Barre syndrome

  • Treatment of last resort for life-threatening systemic lupus erythematosus (SLE) when conventional therapy has failed to prevent clinical deterioration.

    - Clinical and coding expertise for this issue of Oncology Coding Alert provided by Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies  Inc. in Dallas, Ga.

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