Part B Insider (Multispecialty) Coding Alert
CMS Proposes Cutting Apheresis Up To 9%
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Medicare may make a cutting-edge procedure to treat blood disorders impossible to provide.
The 2006 Physician fee schedule proposed rule includes 6.2- to 9-percent cuts for apheresis codes 36514-36516, according to the American Society for Apheresis. And the outpatient prospective payment system rule cuts the code that includes apheresis roughly 28 percent from last year.
Physicians could see reductions of hundreds of dollars in reimbursement for apheresis, says Patricia Jost Golden, the Society's past president. She blames a faulty Medicare process for calculating practice expense, and "improper billing" on the part of some physicians. Because the apheresis codes are fairly new, there isn't much data and physicians may be submitting the wrong charges.
Apheresis has been effective in treating leukemia and has reduced the mortality rate for thrombotic thrombocytopenic purpura (TTP) from 95 to 25 percent, Golden says. Apheresis allows physicians to remove plasma, leukocytes and platelets from patients' blood and replace them with healthy factors.
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