Pathology/Lab Coding Alert

Stem-Cell Codes Add Up to Accurate Reimbursement "New and improved" would be a fair moniker for stem-cell coding in 2003. With 13 new codes, pathologists involved in bone-marrow and peripheral-blood stem-cell services can finally account for each step of the complex procedures performed.

Specialized clinical centers around the country mainly use stem-cell transplant codes, 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 to the AMA CPT Advisory Committee.

Pathology and laboratory services are integral to the stem-cell transplant process. Physicians use the procedure to treat many cancers and certain immunodeficiencies. Stem cells are "parent blood cells" that produce more stem cells and a supply of differentiated, mature blood components including red blood cells, white blood cells and platelets. Found in high concentration in bone marrow and lower concentration in blood, stem cells may be harvested, processed and reinfused into the same individual (autologous transplant) or into a different individual (allogenic transplant).

Although you have an entire list of new codes, using them is not difficult if you realize that they describe the three primary steps of stem-cell services: harvesting, processing/storage and transplanting. With one new code, CPT 2003 also acknowledges physician management of allogenic stem-cell transplant patients.

Source Is Key to Stem-Cell Harvesting Codes Stem cells for transplantation may come from bone marrow or blood and from a self-donor or other donor. If you know the stem-cell source, you can code the harvesting procedure. CPT 2003 did not change the code for bone marrow harvesting: 38230 (Bone marrow harvesting for transplantation). Be sure not to report this service using codes for diagnostic bone marrow sampling, such as aspiration (38220) or biopsy (38221). CPT 2003 has two new codes for blood stem-cell harvesting, which physicians perform using a process called cytapheresis. The procedure involves collecting blood, separating the stem cells, and immediately returning the remaining cells to the patient. The new codes are:   38205 Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogenic     38206 autologous.   These replace deleted code 38231 (Blood-derived peripheral stem cell harvesting for transplantation, per collection). "Multiple cytapheresis sessions are often necessary to collect sufficient stem cells for transplantation," says Kevin Bundy, BB, MT, SBB (ASCP), CLS (NCA), supervisor of the Human Cellular Therapy Laboratory at the Mayo Clinic in Rochester, Minn. Report each session separately using appropriate code 38205 or 38206. Do not report cytapheresis for stem-cell transplantation using the other new therapeutic apheresis codes 36511-36516 (see "CPT 2003 Infuses Lifeblood Into Apheresis Codes" in article 2). List Each Step [...]