Stem Cell Codes Will Rock Your World
Published on Sun Dec 01, 2002
Turn to the bone marrow section of your 2003 CPT book and you'll think Santa Claus came to town early this year. Thirteen shiny new codes for stem cell procedures crowd the page.
Many of these sophisticated transplant codes are used mainly in specialized clinical centers around the country, says Samuel Silver, MD, PhD, medical director of the Cancer Center Network at the University of Michigan and representative of the American Society of Hematology on the AMA CPT Advisory Committee. However, "the principles behind the codes signal important issues" that will affect everyone, so it behooves oncology coders to sit up and take notice. Despite CPT's long list, oncology coders can get their heads around the new codes by understanding that they're divided into three types: call processing, infusion and management codes. Cell Processing Codes Are Wash-and-Wear The first thing coders should notice, Silver says, is that in place of the two previous cell processing codes, there are now nine separate procedures for everything from washing the harvested cells to depletion procedures: 38207 Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage
38208 thawing of previously frozen harvest
38209 washing of harvest
38210 specific cell depletion within harvest, T-cell depletion
38211 tumor cell depletion
38212 red blood cell removal
38213 platelet depletion
38214 plasma (volume) depletion
38215 cell concentration in plasma, mononuclear, or buffy coat layer. There are two main reasons for breaking out these codes: The procedures named are expensive, and they require a lot of work. Essentially, Silver says, CPT is trying to describe in finer granularity what bone-marrow-transplant physicians and technicians do because CPT anticipates more billing and tracking issues in the future.
"We will probably be seeing more stand-alone, nonfacility stem cell laboratories who will want to bill for all the different steps they take rather than lumping them into a single process," Silver predicts. Additionally, these cellular product codes require a tremendous amount of physician oversight because if the doctor does something wrong, the patient at the other end may die. For example, a donor in South Africa donates his stem cells to a patient in Houston. The patient in Houston has received a lethal dose of chemotherapy and awaits his transplant. If anything goes wrong in the lab over the next 12 hours, the patient may die. "It's not like you can take another bag of blood off the shelf," Silver warns. Until this year, physicians weren't receiving any compensation for the enormous risk inherent in these procedures. Now there is a laboratory-based code with a physician work component, which is distinctly unusual, Silver says. The detailed spectrum of new 2003 codes "allows us to itemize the work done in units that make sense," [...]
