Pathology/Lab Coding Alert

Drop ‘stem cell’ terminology — use ‘hematopoietic progenitor’ cell instead.

If your pathologist/hematologist performs transplant or post-transplant cellular infusions, you need to learn a host of changes for 2013.

Let our experts guide you through CPT^® 2013’s new "Transplantation and Post-Transplantation Cellular Infusions" section guidelines, three revised codes, and one new code, to ensure that you capture the pay you deserve for your infusion services.

Face the New and Revised Codes

Your old codes for bone marrow or blood-derived peripheral stem cell transplantation look a lot different in 2013. But that’s not all. CPT^® 2013 also adds a new code for hematopoietic progenitor cell boost after transplant, says Jodi Good, CPC-I, CCS-P, PCS, Manager of Professional Coding Services for Altegra Health Inc.

Drop ‘stem cell’: In addition to new code 38243, CPT^® 2013 revisions to 38240-38241 drop the descriptor language "bone marrow or blood derived peripheral stem cell" in favor of "hematopoietic progenitor cell (HPC)," as follows:

38240 — Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor

38241 — … autologous transplantation

#38243 — … HPC boost

38242 — Allogeneic lymphocyte infusions.

Notice #: The new code (38243) features the "#" symbol, meaning it is out of order numerically. CPT^® places new code 38243 between existing codes 38241 and 38242 to avoid renumbering large numbers of codes.

Decipher Codes With This Glossary

We’ve "translated" the following terms into common language to make sure you understand what’s going on in the new and revised codes:

Hematopoietic progenitor cell (HPC) — Blood-forming cells found in areas such as bone marrow, peripheral blood, or umbilical cord blood

Autologous — Derived from and/or transplanted to the same individual’s body

Allogeneic — Derived from and/or transplanted to genetically different individuals of the same species

HPC boost — Infusion of additional HPCs from the original donor to a patient who has undergone a prior HPC transplantation but demonstrates poor graft function (such as decreasing blood counts — cytopenia). An HPC boost can take place days, months, or years after the original transplant, according to CPT^® 2013 guidelines.

Lymphocyte infusion — transplant of lymphocytes (type of white blood cells) to treat relapse, infection, or post-transplant lymphoproliferative syndrome.

Know What Is — and Isn’t — Included

According to CPT^® 2013 guidelines, you should not report separate codes for the following services in addition 38240-38243, because they’re included in the procedure:

Physician monitoring of physiologic parameters

Physician verification of cell processing

Patient evaluation immediately before, during, and after HPC/lymphocyte infusion

Physician presence and direct supervision of clinical staff during infusion

Management of uncomplicated adverse events, such as nausea and urticaria (hives)

Incidental hydration and fluids used for administration

Concurrent infusions of medications.

Capture separate pay: CPT^® 2013 guidelines also provide information on which services you may report in addition to 38240-38243.

You may report evaluation and management (E/M) codes on the same date as 38240-38243 if the E/M service is separately identifiable and supported by the progress note documentation. Guidelines instruct you to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to identify the separate visit service performed.

The guidelines also state that "post-transplant infusion management of adverse reactions is reported separately using the appropriate E/M, prolonged service or critical care code(s)." Keep in mind, however, that guidelines instruct you to not separately report treatment of uncomplicated adverse events during the infusion.

CPT^® guidelines also specify that you may separately report hydration and medication administration unrelated to the transplant. Append modifier 59 (Distinct procedural service) to show the service was properly ordered and provided beyond what is normally an inclusive, necessary component of an HPC or lymphocyte service.

Don’t miss multiple donors: If an allogeneic transplant involves more than one donor, and "cells from each donor are infused sequentially," you should report multiple units of 38240 — one unit for each donor separately infused.