You Be the Coder:
Bone-Marrow Transplant
Published on Wed Aug 01, 2001
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: For a bone-marrow transplant (BMT) done in a hospital, it is my understanding that the nurse hangs the bag, and the doctor remains in the area for 30 minutes to an hour. The nurse monitors the patient, and if any complications arise, the physician is called.
Can we bill 38240 or 38241 for this procedure, or should we report only an E/M service because the hospital nurse is monitoring the patient?
Also, what are the criteria for billing the BMT procedure codes?
Rhode Island Subscriber
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Answer: A bone-marrow transplant infusion typically takes 30 minutes to an hour, so the physician normally is present during the infusion. However, the nursing staff will continue to monitor the patient after the infusion is complete. The physician must make sure documentation supports the chosen bone-marrow procedure code. Missouri Medicare, for example, states that a history and physical must be performed and noted in the patient record, as well as documentation of the infusion.
The services performed will dictate which codes you use, not which procedures the physician monitored.
A BMT involves professional services (the physician) as well as technical services (hospital staff, bed, monitor and other equipment). When the oncologist supervises a bone-marrow or stem-cell transplant in a hospital setting, bill 38240 (bone-marrow or blood-derived peripheral stem-cell transplantation; allogenic) or 38241 (... autologous) with modifier -26 (professional component) to indicate you are billing for the professional services. The physician practice cannot bill the technical component because it does not provide those services; the hospital bills this portion. | |
