Oncology & Hematology Coding Alert

'Stem cell' makes way for 'hematopoietic progenitor' cell terminology.

The CPT® 2013 updates aren't final quite yet, but that doesn't mean you can't start your preparations now. We'll get you on your way with a look at the expected changes to codes in the 3824x range.

Plan Ahead for This Transplant Coding Overhaul

Your old codes for bone marrow or blood-derived peripheral stem cell transplantation will look a lot different in 2013. But that's not all. CPT® is adding 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.

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

Here's how you can expect the updated codes to appear (remember that changes are still possible before the codes are finalized later in the fall). For the revised codes, text expected to be deleted is crossed out and text to be added is underlined:

• Revised: 38240, Bone marrow or blood-derived peripheral stem Hematopoietic progenitor cell transplantation(HPC); allogeneic transplantation per donor
• Revised: 38241, ... autologous transplantation
• New: 38243, ... HPC boost
• Revised: 38242, Bone marrow or blood-derived peripheral stem cell transplantation Allogeneic lymphocyte infusions; allogeneic donor lymphocyte infusions

Tips to Decipher the Top Changes

Many of the new codes reference hematopoietic progenitor cells, also called HPC. These are blood-forming cells found in areas such as the bone marrow, peripheral blood, or umbilical cord blood.

Code 38240 will soon specify that it is appropriate "per donor." Remember that "allogeneic" means the cells were taken from a donor other than the patient who will receive the transplant. Code 38241 will remain appropriate for transplantation using autologous cells (taken from the recipient at an earlier date).

New code 38243 will be specific to an HPC boost. Final directions for use of this code will be determined by CPT® and payer guidelines. But you already can find the term in certain payer policies, such as the Anthem (Blue Cross Blue Shield) policy for "Hematopoietic Stem Cell Transplantation for Multiple Myeloma and Other Plasma Cell Dyscrasias" (www.anthem.com/medicalpolicies/policies/mp_pw_a045963.htm).

Anthem explains that after transplant, some patients may experience poor graft function, meaning slow recovery of blood counts or decreasing blood counts after an initially successful transplant. In these situations, one approach physicians may choose is a boost, "a non-standardized term that is used to describe an infusion of additional hematopoietic stem cells to an individual who has undergone recent hematopoietic stem cell transplantation and has poor graft function."

The policy specifies that boosts and transplants are not the same thing, so expect to see different medical necessity criteria.