Wiki PRP billing during spine surgery

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stwilley

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We know insurance companies do not reimburse for PRP injections. I have a surgeon that wants to ask his patients to pay for the PRP before surgery in addition to their out of pocket for their spine surgery. Asking the patient to be self pay for the PRP that will be injected during surgery and then bill the CPT such as 63047 to the health insurance. I would like to get some feed back on this?
 
In surgery setting I am thinking PRP would be inclusive to primary procedure. In office setting it should be ok to bill as self pay.
 
Since it's not separately reportable (inclusive) with the primary surgical service, I probably wouldn't in the surgical setting. I just don't think it's a good idea. I guess they could try going the route of ABN, etc. but it still seems fishy and like unbundling to get the patient to pay. I don't know, I would clear it with compliance and the C-levels before doing it. I am not sure it is something for someone at the staff or coder level to decide on. I just feel that it's like trying to get the patient to pay for the closure of the wound or the other tasks that are included in the global by separating it out from the GSP. It seems fishy. It would require ABNs or ABN type forms, pre-notice, collecting the money, etc. if it could even be done. If it is the only procedure done in the office setting that's different.
As far as I know there was an April 2009 CPT Assistant: “The placement/injection of the cells into the operative site is an inclusive component of the operative procedure performed and not separately reported separately.”

Old but: https://www.beckersspine.com/orthop...r-ascs-bottom-line?oly_enc_id=5045F0863212C8J
Coding tip: Beware! Category III code 0232T can only be reported if the PRP injection is performed on a nonsurgical site or when performed unrelated to the surgical site.

Very old but also discusses: https://www.briancolemd.com/wp-content/themes/ypo-theme/pdf/prp-reimbursement-shoulder.pdf

Old forum discussion: https://www.aapc.com/discuss/thread...wgqwuvrzL4PJeADdOvIyF7pLt4-2zpu_o8YxuvgBKubrW

There are varying opinions, I don't know, I guess if done correctly and cleared with compliance, etc. it "might" be something that can be done for surgeries.

Another opinion: Any time a physician uses PRP as part of a larger reconstruction or repair (traumatic or nontraumatic) procedure, it is not separately billable.
 
I do not believe there is any professional fee code that can be billed in this situation.
As usual, I agree with Amy.

20930 would likely be denied based on payor policies. It has no value as an add-on code.
0232T is not appropriate, as this is not a separate injection.
You can use the HCPCS code P9020, but it is likely to be denied based on a lack of medical necessity.
 
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