Oncology & Hematology Coding Alert

We'll show you how to recoup stem-cell transplantation pay When oncologists perform stem-cell procedures, you'll need to know how to code three basic services: harvesting, storage and transplanting.
 
Before you begin choosing stem-cell procedure codes, make sure you know the recent CPT and Medicare changes regarding cell transplantation. In 2003, CPT introduced 12 new stem-cell-related codes (38204-38215), which represent harvesting and transplantation procedures for bone marrow and stem cells. CMS, however, considers codes 38207-38215 invalid for Medicare purposes, says Linda L. Lively, MHA, CCS-P, RCC, CHBME, president and chief executive officer of AMAC, a coding consultant firm in Atlanta. 
 
To help you fine-tune your stem-cell reporting, follow these three tips offered by our coding experts. 1. Pick Harvesting Codes Based on Removal Site You'll need to know the specific stem-cell harvest site to code this procedure accurately.The oncologist may harvest stem cells from bone marrow, blood or a self-donor to treat diseases such as leukemia (204.xx) and nodular lymphoma (202.0x), says Cindy Parman, CPC, CPC-H, RCC, principal and co-founder of Coding Strategies in Powder Springs, Ga.
 
When the oncologist harvests cells from bone marrow, report 38230 (Bone marrow harvesting for transplantation). Typically, the physician removes the marrow with a biopsy needle that he or she inserts into the iliac crest. Make sure you don't report 38220 (Bone marrow; aspiration only) or 38221 (... biopsy, needle or trocar) for the harvesting procedure - 38220 and 38221 represent diagnostic bone-marrow sampling.
 
To abstract stem cells through a patient's blood, oncologists use a process called cytapheresis. This procedure involves collecting blood, separating the stem cells, and immediately returning the leftover cells to the patient.
 
You should report each cytapheresis session separately using 38205 (Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic) and 38206 (... autologous). In 2003, The National Correct Coding Initiative, version 9.0, made 38205, 38206 and 38230 mutually exclusive, meaning that you can't bill these codes together on the same day. Also, you can't unbundle the codes with a modifier, Lively says.
 
This makes sense, because an oncologist probably won't harvest stem cells for the same patient on the same day using both bone marrow and blood sources.
 
Don't confuse cytapheresis with an apheresis procedure, such as 36511 (Therapeutic apheresis; for white blood cells). Oncologists use apheresis to extract a patient's blood and remove certain factors, such as red blood cells (36512) or platelets (36513). The apheresis equipment then returns the remaining blood to the patient, Parman says. 2. Code All Cell Processing and Storage Steps Whether you're reporting services to Medicare or a private carrier will determine the codes you use for  therapeutic processing and stem-cell storage billing.
 
For example, if your oncologist stores a Medicare patient's stem cells after harvesting them, you can safely report [...]