Wiki Platelet Rich Plasma Injections

[cwilson3333]

Having trouble getting injection of platelet rich plasma procedure paid.

I have used Category III Code ... 0232T and been denied.

What about 86999 [unlisted transfusion medicine code and including procedure note.]

Our doctors are starting to perform a number of these procedures, in office and during surgery.

Comments please?

Thanks,

Cw

 

[mmorningstarcpc]

0232T is the correct code. Using 86999 is not correct for PRP injections. Medicare has no RVUs attached to 0232T as it is a tracking code (to see if there is really a need for a permanent code). Some carriers pay for it, some don't. Medicare does not pay for it. Also, those that do cover it, only pay for it when performed by itself, it is inclusive when performed with a primary procedure. Per coding convention (and found at the beginning of the Category III codes) when a Category III code exists, using an unlisted code is incorrect. Coding/billing 86999 in order to get paid, when a code exists, is fraud.