Platelet Gel during Total Knee

[kellit21]

I have a physician who has started using platelet gel after completing a total knee arthroplasty. His description says he sprayed the area with platelet gel. Has anyone ever seen this? Can we bill for it? I found code G0460, but not sure if its billable.

 

[kellit21]

I really need some help...has anyone seen this??

 

[thomas7331]

From the limited description you've given it's not really clear what the physician is doing or why. But it certainly does not sound like it meets the description of G0460, which is for use of autologous (i.e. take from the patient's own blood) platelet rich plasma for the purpose of treatment of chronic wounds and also includes the work involved in the preparation of the product - it certain doesn't meet the description the provider is giving here of spraying a gel on a post-operative wound.

In any case, it's been my experience that most payers consider platelet treatments to be experimental and of uncertain or unproven effectiveness and only cover them in very limited circumstances, if at all. Unproven treatments generally do not have assigned codes, so you most likely will need to bill this with an unlisted code. If the provider is doing no more than spraying a purchased product on a wound, this likely is inclusive to the global post-operative care and the only thing you'd be able to bill is for the product itself, for which you'd likely need to assign an unlisted code (perhaps J3580 - 'unclassified biologics') and submit an accompanying description and/or invoice to the payer for consideration. My suspicion is that it will be hard to get a payer to reimburse this.

 

[Orthocoderpgu]

I really need some help...has anyone seen this??

G0460 states that it is for treating non-diabetic ulcers. So no, you cannot use it. It's a form of PRP which does not get billed to insurance.