Oncology & Hematology Coding Alert

Key: Allogeneic vs. autologous mean different payouts.

Stem cell transplants, used to treat diseases like leukemia and nodular lymphoma, are complex procedures that involve many steps. Along the way, you can make errors and lose out on maximizing your practice’s reimbursement. From locating the initial site of harvest to the conclusion of the transplant, follow these Do’s and Don’ts to maintain accuracy in your report.

Do Start Coding Early

Start your coding early to avoid missing out on any reimbursement available throughout the transplant process. Identify immediately whether your oncologist is harvesting stem cells from bone marrow or blood because depending on which site it being operated on, a different coding strategy is required.

For bone marrow harvesting, use the following two CPT^® codes:

• 38230 (Bone marrow harvesting for transplantation; allogeneic) or
• 38232 (Bone marrow harvesting for transplantation; autologous).

For blood harvesting, use the following two CPT^® codes:

• 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).

Don’t Confuse Autologous and Allogenic

Notice you have two codes for each harvesting site. The bone marrow and blood cell codes are differentiated by the whether the harvest is allogeneic and autologous. Know these definitions to ensure you select the correct code:

“Allogenic if from a human donor,” says Kelly Loya, CPhT, CPC-I, CHC, CRMA, Managing Director of Pinnacle Enterprise Risk Consulting Services. “Autologus is tissue originating from the same individual who will receive the tissue from the patient’s own body.”

Familiarization with the terms allogeneic and autologous helps you ensure that your practice receives the reimbursement it deserves.

Don’t Confuse Procedure Codes

Similar bone marrow codes exist which can cause misdirection. Bone marrow codes that involve aspirations or diagnostic sampling look like harvesting codes, especially in their descriptions, but these are altogether different procedures. Be careful not to confuse a bone marrow stem cell harvest with operations represented by codes like 38220 (Bone marrow; aspiration only) and 38221 (Bone marrow; biopsy, needle or trocar).

Blood cell codes can also be tricky. Some codes mention the harvesting technique known as apheresis, and you can easily substitute these incorrect codes with the proper harvesting code. These other apheresis codes however are not sufficient in representing the total workload involved in a harvesting procedure. Keep a look out for codes that mention apheresis like 36511 (Therapeutic apheresis; for white blood cells), 36512 (Therapeutic apheresis; for red blood cells) and 36513 (Therapeutic apheresis; for platelets) and take care not to confuse them with the main blood cell codes 38205 and 38206.

Do Keep Track of Blood Cell Harvesting Sessions

Harvesting blood cells are reported for every session in which this procedure occurs. The harvesting is completed through a process called cytapheresis where blood is sampled from a patient donor and stem cells in the blood are separated on a cellular level. From here, elements of the blood like plasma are transfused back into the donor. In total, the blood is withdrawn, stem cells are collected, and the remaining elements are returned to the patient.

An oncologist will often perform these cytapheresis procedures more than once to collect a healthy amount of stem cells for the transplant operation. For each session, report the procedure with either blood cell harvesting code 38205 or 38206.

Don’t Bundle These Codes

Can you bundle codes 32805 and 32806 together? “If you look at the current National Correct Coding Initiative (CCI), 32806 is mutually exclusive to 32805. Therefore, you cannot bill these codes together in any circumstance. So, for the federal payors, the answer is always no,” says Kristen Taylor, CPC, CHC, Managing Director at Pinnacle Enterprise Risk Consulting Services.

The bone marrow and blood cell harvesting codes are not be billed together on the same day. These codes are mutually exclusive, meaning that it is medically unlikely these procedures will occur back-to-back. Keep in mind that if you do try to bundle these codes together, an auditor will most likely kick the claim back to you and deny your claim.

Do Learn the Preservation and Storage Codes

Harvesting stem cells involves freezing and storing the gathered elements. Most coders report only the harvesting but you can code for this preservation process. You can report every step of the harvesting process and maximize your clinic’s reimbursement by learning the following storage codes.

• 38207 (Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage)
• 38208 (Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, without washing, per donor) » »
• 38209 (Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, with washing, per donor).

Tip: Similar codes describe situations when the cryopreservation process is utilized for diagnostic purposes. However, because codes like 88240 (Cryopreservation, freezing and storage of cells, each cell line) and 88241 (Thawing and expansion of frozen cells, each aliquot) cannot be bundled with the stem cell transplant codes, you cannot use these to report for reimbursement. Codes 88240 and 88241 are primarily used by laboratories to report clinical tests.