Pathology/Lab Coding Alert

Usually, the pathologist responsible for apheresis services also provides evaluation and management (E/M) of the patient before and during the procedure. Some of these services are bundled, but others should qualify for reimbursement if properly coded, states Catherine Saporito, MT (ASCP), SBB, blood bank manager at University of Illinois Hospital in Chicago.

Apheresis is the process of removing a patients blood, separating out components such as plasma, leukocytes or stem cells, and returning the remainder. Typically, a pathologist specializing in transfusion medicine carries out the process, working in close coordination with the patients primary care physician (PCP). It is often the blood bank physician who evaluates and monitors the patient before, during and after the apheresis procedure, says Saporito. This might include a review of patient history, physical examination, and writing clinical orders, progress notes, a consultation report and discharge directions. The work involved in these tasks varies based on the indication for the procedure and the patients condition.

Adsorption Column and Stem Cell Apheresis

A new apheresis code in CPT 2000 describes the process of passing the blood through an adsorption column during apheresis. For example, a Pro-Sorba adsorption column may be used during a three-month course of repeat plasmapheresis to remove certain factors from the blood of a rheumatoid arthritis patient (714), says James W. Smith, MD, Ph.D., associate medical director of the Oklahoma Blood Institute, a blood center for transfusion medicine and volunteer donors. In this case, code 36521 (therapeutic apheresis; with extracorporeal affinity column adsorption and plasma reinfusion) would be reported. Because this procedure is repeated weekly, probably a venous access device would be instated to provide ease of access at subsequent visits, says Smith. The appropriate CPT code for venous access, such as 36533 (insertion of implantable venous access device, with or without subcutaneous reservoir), would be used to report that service separately from the apheresis service. When the apheresis treatments are complete, the appropriate device removal code, such as 36535 (removal of implantable venous access device), would be reported.

A similar scenario would exist for a patient with unresponsive hyperlipidemia [272.4], states Smith. A patient with uncontrollable LDL cholesterol may require plasmapheresis using an adsorption column as often as twice a week to keep his or her cholesterol level in check. Again, code 36521 would be used to report this service.

Non-Hodgkins lymphoma (202.8) also may require repeated apheresis, but in this case its for stem cell collection, says Smith. CPT provides a separate code for this apheresis and cell accumulation procedure: 38231 (blood derived peripheral stem cell harvesting for transplantation, per collection).
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