Oncology & Hematology Coding Alert

Question: What is the correct way to bill for apheresis? Do I use 36514 for the removal, then use another code such as 36516 for the reinfusion of albumin or fresh frozen plasma (FFP)?

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Answer: Therapeutic apheresis is a procedure involving the separation and removal of abnormal blood components such as white blood cells or proteins in the plasma. After the components are removed, the normal blood is returned to the patient’s body.

Each of the therapeutic apheresis codes (36511-36516) describes the abnormal blood component the apheresis is designed to remove. So, code choice is dependent on whether your provider used the procedure to remove white blood cells (36511), red blood cells (36512), platelets (36513), or plasma (36514) from the patient’s blood. In your scenario, if plasma was removed in the apheresis process, then 36514 (Therapeutic apheresis; for plasma pheresis) would be correct.

The difference between codes 36511-36514 and 36516 (Therapeutic apheresis; with extracorporeal immunoadsorption, selective adsorption or selective filtration and plasma reinfusion) is that 36511-36514 include the replacement of the components removed, while 36516 describes the removal, filtration (the extracorporeal immunoadsorption, or filtration outside of the body), and reinfusion of the component from the patient’s body via blood plasma. So, you would not be correct to code 36514 for the removal of plasma and 36516 for the reinfusion.

Don’t forget: CPT^® Assistant, Vol. 28, Issue 5 (2018) says you can code for “colloid-volume replacement” — the substance reinfused into the patient’s blood to make up blood volume once the process removes the abnormal plasma in therapeutic plasma apheresis. This means you can use a HCPCS Level II code such as P9047 (Infusion, albumin (human), 25%, 50 ml) or J7100 (Infusion, dextran 40, 500 ml) in addition to the 36514.