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.