Assistance with umbilical cord stem cell application for internal med/ortho etc


Corinth, TX
Best answers
I was approached by a gentleman that previously had a collection company producing his claims. Here is the situation. He is NOT a provider, yet has an 2 NPI's. One has the taxonomy of "blood work" yet is not considered a lab. He receives donated umbilical cord blood typically from a C-section. The blood/vein is removed and taken away to the lab where the blood is spun in a machine until only stem cells are left. These stem cells are applied/sprayed I internal or orthopedic cases where the first surgery was not successful. I am trying to find out the codes to bill the patients insurance as a "dme/product vendor" because the owner is not a physician and is not performing the surgery. The frozen stem cells are available for use as the physician deems necessary. The 40+ cases performed, the patients are doing remarkably well.

He had a prior billing company that coded the same codes and are :
All were billed on 4 lines. The 1st line was standard CPT code then the following 3 utilized 59 modifier. He should be able to code for these services as the lab/machine prepared the umbilical cord blood into stem cell and was frozen, preserved, thawed etc. Unfortunately the previous billing company informed him he could utilize the same pre-cert/pre-auth as the hospital! I'm not sure how they stay in business.

Does anyone have any information on this fairly new procedure? Obviously it is allogeneic as it is a different donor aka maternal mother!

The other downfall is the "old school" MD did not state how many CC's/units utilized however it should state 4 cc's so that is why I am believing they billed a total of 4 units ??

If someone has experience and can lead me to it, I would GREATLY appreciate it.

Thank you