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Wiki Platelet rich plasma application for non-healing wounds
- Thread starter gquevedo
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sphillips79
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I use 36513
mspeicher1
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Prp
We absolutely have to send documentation every time we use it, and mostly it gets denied. There are very few procedures insurance actually considers this necessary for. Most uses are experimental. Check the payers clinical policy bulletins.
We absolutely have to send documentation every time we use it, and mostly it gets denied. There are very few procedures insurance actually considers this necessary for. Most uses are experimental. Check the payers clinical policy bulletins.
kjstearns
Guru
This is per Margie:
Updated May 21st, 2009:
I just got a reply this morning (5/21/09) from the AMA and here it is (As of 5/21/09....):
"May 18, 2009 represents consensus reporting according to our CPT Advisors representing the American Academy of Orthopaedic Surgeons, American Orthopaedic Association and the American Orthopaedic Foot and Ankle Society as of May 14 and May 18, 2009. At that time, the orthopaedic CPT advisors clarified two aspects of this issue: 1) the injection of the platelet rich cells at the time of a definitive surgical procedure; and 2) when this injection is performed into a tendon or joint independent of another surgical procedure.
The CPT Advisors indicated that "the American Academy of Orthopaedic Surgeons Global Service Data book specifically states in # 1 that local infiltration of most agents in included in the surgical procedure performed. Injecting plasma is not any different."
The CPT Advisors also specifically clarified the use of CPT codes when the platelet cells in plasma injection is performed independent of another definitive surgical procedure: "If injection of the platelet rich cells is performed into a joint (independent of a concurrent definitive surgical procedure), then code 20600, 20605 or 20610 is reportable. If injecting into a tendon, then 20550 is appropriate and if into a tendon origin/insertion then 20551 regardless of the anatomic site involved.
the platelet rich cell injection is not reportable either using code 24357 Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); percutaneous, nor should code 20550 be reported in addition to 24357 when a "tenotomy" of the elbow is performed. It would not be appropriate to report code 24357 to describe the injection of platelet rich cells into a tendon.
ICD-9 Coding Clinic, Vol 19 No 2, 2nd Qtr 2002
"Question:
Our surgeons are now using PLASMA RICH PLATELETs to augment bone graft procedures. During the surgical procedure, a small sample (approximately 100 cc) of the patient's blood is drawn and placed into a disposable blood chamber(s) for processing in the Symphony PLATELET Concentrate System centrifuge. In the process, PLATELET poor PLASMA volume is removed from the blood samples. Approximately 10 ml of PLATELET RICH PLASMA (PRP) is procured. The surgeon conjugates the PLATELET concentrate with bone graft material and then applies the material to the wound site prior to closure. How should the procuring and application of the PRP via the automated processing system be coded or would this be considered a component of the bone graft procedure?
Answer:
Do not assign a unique code for the procuring or the application of the PLASMA RICH PLATELETs, since the use of the PLASMA is considered an integral part of the total procedure."
We have done a few of these and have sent documentation in as well.
Hope this helps!
Kirsten, CPC
Updated May 21st, 2009:
I just got a reply this morning (5/21/09) from the AMA and here it is (As of 5/21/09....):
"May 18, 2009 represents consensus reporting according to our CPT Advisors representing the American Academy of Orthopaedic Surgeons, American Orthopaedic Association and the American Orthopaedic Foot and Ankle Society as of May 14 and May 18, 2009. At that time, the orthopaedic CPT advisors clarified two aspects of this issue: 1) the injection of the platelet rich cells at the time of a definitive surgical procedure; and 2) when this injection is performed into a tendon or joint independent of another surgical procedure.
The CPT Advisors indicated that "the American Academy of Orthopaedic Surgeons Global Service Data book specifically states in # 1 that local infiltration of most agents in included in the surgical procedure performed. Injecting plasma is not any different."
The CPT Advisors also specifically clarified the use of CPT codes when the platelet cells in plasma injection is performed independent of another definitive surgical procedure: "If injection of the platelet rich cells is performed into a joint (independent of a concurrent definitive surgical procedure), then code 20600, 20605 or 20610 is reportable. If injecting into a tendon, then 20550 is appropriate and if into a tendon origin/insertion then 20551 regardless of the anatomic site involved.
the platelet rich cell injection is not reportable either using code 24357 Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); percutaneous, nor should code 20550 be reported in addition to 24357 when a "tenotomy" of the elbow is performed. It would not be appropriate to report code 24357 to describe the injection of platelet rich cells into a tendon.
ICD-9 Coding Clinic, Vol 19 No 2, 2nd Qtr 2002
"Question:
Our surgeons are now using PLASMA RICH PLATELETs to augment bone graft procedures. During the surgical procedure, a small sample (approximately 100 cc) of the patient's blood is drawn and placed into a disposable blood chamber(s) for processing in the Symphony PLATELET Concentrate System centrifuge. In the process, PLATELET poor PLASMA volume is removed from the blood samples. Approximately 10 ml of PLATELET RICH PLASMA (PRP) is procured. The surgeon conjugates the PLATELET concentrate with bone graft material and then applies the material to the wound site prior to closure. How should the procuring and application of the PRP via the automated processing system be coded or would this be considered a component of the bone graft procedure?
Answer:
Do not assign a unique code for the procuring or the application of the PLASMA RICH PLATELETs, since the use of the PLASMA is considered an integral part of the total procedure."
We have done a few of these and have sent documentation in as well.
Hope this helps!
Kirsten, CPC