Oncology & Hematology Coding Alert

Question: Our physician used platelet rich plasma (PRP) injections in a patient with bone tumor who underwent a bone reconstruction. How can we report for PRP Injections? Is 38230 the correct code?

North Carolina Subscriber

Answer: The American Medical Association (AMA) Current Procedural Terminology (CPT^®) introduced a new category III (new technology) code in 2010 for the performance of platelet rich plasma (PRP) injection procedures. You may submit 0232T (Injection[s], platelet rich plasma, any site, including image guidance, harvesting and preparation when performed) for these injections. Local coverage determinations from several Medicare Administrative Contractors are still indicating this is currently a noncovered service by Medicare. 

What Is PRP? PRP is a treatment option focused on healing joints: ligaments, tendons, and cartilage. A primary problem is there is little blood flow in the joint tissues compared with muscle tissues. PRP stimulates blood flow to the area which allows for the breakdown of unhealthy tissue and the creation of new, healthy tissue.

Benefits of PRP: The primary advantage of PRP is that blood platelets involved in healing damaged connective tissue are placed directly into the area -- rather than wait for the body to do so on its own. By using one’s own blood platelets, which the body quickly replaces, rejection is not an issue.

Avoid these codes: Code 38230 (Bone marrow harvesting for transplantation; allogeneic) is not the right choice for reporting a PRP. Other codes that may be inappropriate to report a PRP include the following:

• 36513 (Therapeutic apheresis; for platelets)
• 86985 (Splitting of blood or blood products, each unit)
• 86940 (Hemolysins and agglutinins; auto, screen, each)
• 20926 (Tissue grafts, other [e.g., paratenon, fat, dermis]),
• 20552 (Injection[s]; single or multiple trigger points[s], 1 or 2 muscle[s]),
• 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]), and
• 36514 (Therapeutic apheresis; for plasma pheresis).

Note: These codes do not describe a PRP injection from the patient’s blood, drawn and centrifuged, and injected back into the involved anatomic site.