Oncology & Hematology Coding Alert

Question: What are the correct codes to use for peripheral stem cell collection, processing and storage? We now use 38230, 38240, 38241, 88240 and 88241. Are these correct?

Wyoming Subscriber

Answer: Factors you need to consider if you are going to bill for the 88240 (cryopreservation, freezing and storage of cells, each cell line) and 88241 (thawing and expansion of frozen cells, each aliquot) include whether the practice owns its own lab or sends the patient or specimen out and if these procedures (88240 and 88241) are provided in the office or in an inpatient or outpatient facility. The office or facility that performs the transplantation is responsible for billing Medicare.

Coding for bone marrow harvesting includes codes 38240 (bone marrow or blood-derived peripheral stem cell transplantation; allogenic) and 38241 ( autologous). Aside from coding 38240, coders should also include 86915 (bone marrow or peripheral stem cell harvest, modification or treatment to eliminate cell type[s], [e.g., T-cells, metastatic carcinoma]) for modification, treatment and processing of bone marrow specimens.

A practice or facility that performs bone marrow collection and transplantation service can also bill for cryopreservation, freezing and storage of blood-derived stem cells for transplantation by using 88240. For thawing and expansion of blood-derived stem cells for transplantation, use 88241.

When 88240 or 88241 is used, practices may also be able to bill for 86915, 86890 (autologous blood or component, collection processing and storage; predeposited) and 86985 (splitting of blood or blood products, each unit). If the office or facility collected the bone marrow and provided services prior to transplantation, they are entitled to reimbursement for those services, including storing the specimen and splitting of blood.

To code appropriately, providers must consider four things:

the role and relationship among the types of blood cells used for treatment of malignant diseases;
the required sequential acquisition;
the unique preservation process; and
the infusion technique used.

Answered by Lillie McAlister, CPC, president of Double Diamond Enterprises, a coding and billing consulting firm in Conroe, Texas.