Wiki Plasmapharesis on newborn

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cmcgarry

cmcgarry

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I could use some advice on appealing a denial from our local BCBS carrier for plasmapharesis (code 36514) on a newborn in Intensive Care, with the diagnosis of 776.1, neonatal thrombocytopenia. The baby also has dx codes 776.5, 775.81 and 774.6. They are stating that according to their medical policy, since the thrombocytopenia is not TTP or ITP, plasmapharesis is considered experimental/investigational. I obtained a copy of their policy, which states that plasmapharesis is covered for emergent idiopathic thrombocytopenic purpura. Do any of you think I have a case for appealing based on the fact that this could be considered emergent? Without treatment of the thrombocytopenia, the neonate could well have died.

Thanks for any help!
Cindy
 
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