Oncology & Hematology Coding Alert

 Should you report a code for every stem cell collection session? Find out.

When oncologists perform stem-cell procedures, you’ll need to know each step of the transplant. The reason is your oncologist’s role may not only pertain to the process of stem cell transplant, but also the management involved in carrying out a donor search.

Did you know? You can earn for the progenitor cell donor search and acquisition (physically acquiring the progenitor cells). For donor search and procurement of hematopoietic cells, you submit code 38204 (Management of recipient hematopoietic progenitor cell donor search and cell acquisition).

Here is a guide for earning during each step of stem cell transplant procedure.

2 Steps Show You How to Tackle Stem Cell Coding

Check documentation to confirm the specific stem-cell harvest site to accurately code the harvesting procedure, says Leah Fuller, CPC, Consultant, Pinnacle Enterprise Risk Consulting Services, LLC, CO.

Step 1: Locate site of harvest: Your oncologist may harvest stem cells from bone marrow or blood to treat diseases such as lekemia and nodular lymphoma.

Step 2: Autologous vs allogeneic: After you have confirmed the origin of the stem cell from bone marrow or blood, you need to determine if the harvest was obtained from the patient (autologous) or from another donor (allogeneic). In autologous transplantation, the oncologist takes cells from the patient’s body, such as from marrow or blood, and reintroduces the cells to the patient following intensive chemotherapy.

Depending upon the allogeneic or autologous harvest of the hematopoietic progenitor cell from blood, you choose from the following two codes:

• 38205 (Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic)
• 38206 (Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous).

Cytapheresis: Cytapheresis is the procedure for blood cell harvesting. In this procedure, blood is withdrawn from the donor, cellular components from the blood are separated, and the plasma and other formed elements are again transfused back into the donor. In other words, this procedure involves collecting blood, separating the stem cells, and immediately returning the remaining cells to the patient. More than one collection session may be required to acquire the amount needed for transplanting, Fuller says.

Keep count of sessions:  Your physician will often perform multiple sessions of cytapheresis to collect sufficient stem cells for transplantation. You report one unit of 38205 or 38206 for each session of stem cell collection.

Be Specific for Bone Marrow Harvesting

When your physician harvests stem cells from the bone marrow, you’ll submit code 38230 (Bone marrow harvesting for transplantation; allogeneic) or 38232 (Bone marrow harvesting for transplantation; autologous), depending upon the allogeneic or autologous sites of harvest.

Note: Be sure not to report this service using codes for diagnostic bone marrow sampling, such as aspiration or biopsy. Hence, you should not report codes 38220 (Diagnostic bone marrow; aspiration(s)) or 38221 (Diagnostic bone marrow; biopsy(ies)).

Take care not to confuse cytapheresis with an apheresis procedure, such as 36511 (Therapeutic apheresis; for white blood cells). Oncologists use apheresis to extract a patient’s blood and remove certain factors, such as red blood cells (36512) or platelets (36513). The apheresis equipment then returns the remaining blood to the patient.

Watch the bundle: The National Correct Coding Initiative (NCCI) considers 38205, 38206 and 38230 as mutually exclusive. This means you can’t bill these codes together on the same day. Additionally, it is not appropriate to unbundle these codes with a modifier. It is unlikely harvesting stem cells for the same patient on the same day would involve both bone marrow and blood sources. Additionally, an autologous and allogeneic harvest would not occur for the same patient on the same day.

Code for Cell Processing and Storage

Make note of steps taken to preserve the stem cells. The process of preservation may involve freezing of the cells, storing them, thawing, and washing. You can accordingly choose from the following codes:

• 38207 (Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage)
• 38208 (Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, without washing, per donor)
• 38209 (Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, with washing, per donor).

Do not confuse these codes with those for cryopreservation, storage and thawing for diagnostic purposes, i.e. 88240 (Cryopreservation, freezing and storage of cells, each cell line) and 88241 (Thawing and expansion of frozen cells, each aliquot). Remember to report 88240-88241 for procedures performed in a clinical laboratory setting.

During the process of preparing the hematopoietic progenitor cells, the provider may eliminate a specific population of cells. This may make the progenitor cells more likely to be accepted by the recipient, minimizing chance of rejection.

For example, to reduce chances of rejection, your physician may subject progenitor cells to T-cell depletion. In this situation, you’ll submit 38210 (Transplant preparation of hematopoietic progenitor cells; specific cell depletion within harvest, T-cell depletion).

To avoid any potential reintroduction of tumor cells into the patient, your provider may subject the hematopoietic progenitor cells to removal of any residual tumor cells. For tumor cell depletion, you’ll report 38211 (Transplant preparation of hematopoietic progenitor cells; tumor cell depletion).

Similarly, for removal of red blood cells, platelets, and plasma depletion, you report codes 38212 (Transplant preparation of hematopoietic progenitor cells; red blood cell removal), 38213 (Transplant preparation of hematopoietic progenitor cells; platelet depletion), and 38214 (Transplant preparation of hematopoietic progenitor cells; plasma [volume] depletion), respectively.

You may read your provider reduced the plasma volume to prepare the cellular solution for transplant. This essentially helps to reduce the risk of toxicity due to the cryoprotective solution used in freezing and storing. In addition to this, removal of buffy coat layer after centrifugation of the progenitor cell solution, helps to remove mononuclear cells and platelets. For this procedure, you’ll submit 38215 (Transplant preparation of hematopoietic progenitor cells; cell concentration in plasma, mononuclear, or buffy coat layer).