Oncology & Hematology Coding Alert

Question: I understand there's a national coverage determination that says Medicare covers allogeneic HSCT under coverage with evidence development. But how do I code for that?

New York Subscriber

Answer: You are correct that Medicare covers allogeneic hematopoietic stem cell transplantation (HSCT) for myelodysplastic syndrome (MDS) when provided as part of a Medicare-approved clinical study that meets Coverage with Evidence Development (CED) criteria.

For physician claims for dates of service on or after Aug. 4, 2010, you should report the following:

CPT: 38240 -- Bone marrow or blood-derived peripheral stem cell transplantation; allogenic

ICD-9: 238.75 -- Myelodysplastic syndrome, unspecified

ICD-9: V70.7 -- Examination of participant in clinical trial

Modifier: Q0 -- Investigational clinical service provided in a clinical research study that is in an approved clinical research study

Place of Service Code: 21 (Inpatient hospital) or 22 (Outpatient hospital).

Resource: CMS outlines coding requirements for HSCT in MLN Matters article MM7137 (www.cms.gov/MLNMattersArticles/downloads/MM7137.pdf).