Oncology & Hematology Coding Alert

Change to global days offers new option for E/M reporting.

Prepare to track down some donor details before you code bone marrow harvesting. CPT® 2012 wants to know.

For 2011 dates of service, if someone had asked, "Does coding for bone marrow harvesting differ based on whether the patient donates the cells or whether another person donates the cells?" the answer would have been, "No."

But a code revision and a code addition in CPT® 2012 change that answer to "Yes," effective Jan. 1, 2012.

Consider this revision of 38230:

• 2011: 38230, Bone marrow harvesting for transplantation
• 2012: 38230, Bone marrow harvesting for transplantation; allogeneic.

Because 38230 is specific to allogeneic harvest in 2012, CPT® also created a code for autologous harvest: 38232, Bone marrow harvesting for transplantation; autologous.

Match the Codes to the Procedures

To apply the codes correctly, remember that "auto" means "self" and "allo" means "other."

For bone marrow transplant coding, "autologous" indicates the cells are from the same individual, says Kelly Loya, CPC-I, CHC, CPhT, managing consultant for Sinaiko Healthcare Consulting Inc., a division of Altegra Health.

So autologous means a single patient donates the cells (38232) and then receives those cells back at a later date and through a separately reportable service (38241, Bone marrow or blood-derived peripheral stem cell transplantation; autologous).

Allogeneic means the cells are from someone other than the patient. The technical definition of allogeneic is "genetically different but from the same species," Loya says. For allogeneic harvesting (38230), the donor may be either related or unrelated to the patient. Later, when the patient receives the cells donated from a different individual, you should report 38240 (Bone marrow or blood-derived peripheral stem cell transplantation; allogeneic) for the transplant.

Straight from the source: Medicare addresses stem cell transplantation in Claims Processing Manual 100-04, chapter 3, section 90.3, Loya says: "Stem cell transplantation is a process in which stem cells are harvested from either a patient's or donor's bone marrow or peripheral blood for intravenous infusion. Autologous stem cell transplants must be used to effect hematopoietic reconstitution following severely myelotoxic doses of chemotherapy and/or radiotherapy used to treat various malignancies. Allogeneic stem cell transplant may also be used to restore function in recipients having an inherited or acquired deficiency or defect. Bone marrow and peripheral blood stem cell transplantation is a process which includes mobilization, harvesting, and transplant of bone marrow or peripheral blood stem cells and the administration of high dose chemotherapy or radiotherapy prior to the actual transplant."

Capture New Opportunity to Code Follow-Up

Wording changes aren't the only news you need to know for stem cell harvest coding. The number of global days has a revision for 2012, as well.

In 2011, Medicare gave 38230 a 10-day global period. That meant that E/M services on the day of the procedure and during the 10-day postoperative period generally weren't payable when the visit was related to the outcome of the procedure, as defined by the global surgical package rules.

According to the 2012 Medicare Physician Fee Schedule (Final, in comment period), codes 38230 and 38232 have a global period of 000 for 2012. Reason: "These services rarely require overnight hospitalization and physician follow-up in the days following the procedure."

The change to 000 global days means that you may report E/M services after the procedure date separately. (E/M services related to the procedure and performed on the day of the procedure still are included in the procedure code fee.)

Trade-off: Code 38230's work relative value units (RVUs) decrease from their 2011 level. In 2011, the code was assigned 4.85 work RVUs. The values were intended to include payment for 99238 (Hospital discharge day management; 30 minutes or less) and 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...).

In 2012, both 38230 and 38232 have work RVUs of 3.09. The silver lining is that Medicare did not go so far as to subtract the full value of 99238 and 99213 from the RVUs. That would have resulted in a work RVU of 2.60, and CMS stated in the final rule that "a work RVU of 2.60 would place these services too low compared to similar services."