Podiatry Coding & Billing Alert

If the PRP was part of a larger surgical/repair procedure, you should do this.

Increasing number of podiatrists are resorting to the use of platelet rich plasma (PRP) injections in the treatment of fasciosis and tendinosis even though the procedure is still an evolving concept. If you do not know how to tell whether the PRP is a standalone or secondary procedure, you may be heading for an audit disaster.

To minimize denials and save precious time, discover what PRP involves, what you should report, and what codes you should avoid.

Put PRP in Perspective

Usually, podiatrists may use PRP (also known as autologous PRP) for these cases:

• Plantar fascia or Achilles tendon causing heel pain
• Acute ligament and muscle injuries
• To minimize arthritis related symptoms in ankles and toes.

“Podiatrists also use this therapy to alleviate the delayed healing of fractures,” informs Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va.

Podiatrists usually perform the injection process in the office. The podiatrist, with or without ultrasound guidance, extracts a small amount of blood from the affected region, and runs it through a centrifuge, which separates the platelets from the rest of the blood and increases the concentration of the platelets. The increased and concentrated platelets are combined with the remaining blood to create the PRP injection. Usually a 30-cc blood draw produces 4 cc to 6 cc of platelet rich plasma material, which is sufficient for most injection types in the foot and ankle. PRP stimulates blood flow to the area which allows for the breakdown of unhealthy tissue and the creation of new, healthy tissue. Patients heal faster.

Ultrasound guidance is not essential but has allowed for far more accurate and improved placement of the injection material in our hands.

Safely Submit PRP Claims as Standalone Service

If the podiatrist calls in a patient specifically for PRP therapy and provides no other therapeutic service on that day, you can code the PRP with a dedicated code 0232T (Injection[s], platelet rich plasma, any site, including image guidance, harvesting and preparation when performed).

Watch yourself: According to National Correct Coding Initiative (CCI) edits, as the code 0232T includes imaging guidance, you cannot report any imaging code such as:

• 76942 — Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation;
• 77002 — Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device);
• 77012 — Computed tomography guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), radiological supervision and interpretation; or
• 77021 — Magnetic resonance guidance for needle placement (e.g., for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation.

Additionally, you cannot also report any platelet concentration service such as 86965 (Pooling of platelets or other blood products).

Earlier you may have reported the service with an appropriate injection code, such as 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar “fascia”]) or 20551 (Injection[s]; single tendon origin/insertion). If the surgeon did the blood draw and platelet processing, you may have reported 86999 (Unlisted transfusion medicine procedure). “They cannot be reported now, and most times PRP is not a pain procedure so I would definitely recommend obtaining a prior authorization,” Beresh says.

Give a Long Berth to These Dodgy Codes

There are many coders out there who may be tempted to report other code combos, but you should steer clear of them. The American Medical Association (AMA) has stipulated that it is inappropriate to report code 86985 (Splitting of blood or blood products, each unit) or 86999 (Unlisted transfusion medicine procedure) to describe the extraction of the platelets. Additionally, stay away from codes specific to aspiration or harvesting of bone marrow (e.g., 38220, 38230, etc.) when the procedure is being performed to obtain platelet rich plasma. They do not describe a PRP injection from the patient’s blood, drawn and centrifuged, and injected back into the involved anatomic site.

Stick to Surgical Codes for Repair + PRP

If the PRP was part of a larger surgical/repair procedure, you will report only the repair procedure.

Example: A patient undergoes an ankle fracture repair. The podiatrist draws the patient’s blood, centrifuges and extracts the PRP, and then injects the PRP back into the operative site.

Although you might want to reflect the podiatrist’s work with a code, you should consider the platelet instillation into the surgical site as part of the surgery. In other words, you should not code for PRP in this situation.

Keep Track of Evolving Guidelines

Your best bet to get paid for the PRP service is to submit all the work done by the podiatrist in the documentation and set the fee high to include all that work. However, as there is no official fixed payment for the service and the payers don’t like to pay for this code so you should always let the patients know beforehand and get an ABM so that they know they will most likely be responsible. Another way to collect payment upfront to avoid hassles. Ensure you are in sync with your payer before reporting PRP therapy.

You may be tempted to bill for an E/M in absence of 0232T payment guidelines for most payers, but billing for E/M is a strict no-no if the purpose of the encounter was specifically for the injection.

As of October 2015, CMS covers autologous platelet-rich plasma (PRP) only for patients who have chronic non-healing diabetic, pressure, and/or venous wounds.

For more info, please visit https://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/Autologous-Platelet-rich-Plasma-PRP.html

Administration of PRP is a procedure and is, therefore, not subject to regulation by the Food and Drug Administration (FDA). However, the devices used to prepare PRP are regulated by the FDA premarket approval process. Several centrifuge devices have been approved by the FDA for preparation of PRP, such as the Cascade® Autologous Platelet System.