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PRP injections

  1. #1
    Default PRP injections
    Medical Coding Books
    If anyone is already performing these I would appreciate any input you may be able to offer. Do we need a CLIA number to draw, centrifuge, and re-introduce the PRP to the injury site?

    We are considering using the 36415 for the venipuncture and 86999 for the 'procedure' until July when the category three code that encompasses the entire procedure '0232T' will be implemented. It is debateable, however, if the 0232T will be the better charge, or sticking with the 20550,20551 or other injection code would be best? Of course that is for the stand alone procedure - not intraoperatively.

    Intraoperatively the consideration is the P9020, but I don't know how reimbursable that will be either, probably inclusive? It has been considered to do this on a self-pay basis only, considering it can expedite healing time up to 30%, but we are trying to cover all of our bases. Any experience or suggestions would be welcome. Thank you,

  2. #2
    After some further research I find our lab code would be 86999 and this code is excluded from CLIA edits. It would not be necessary to obtain a CLIA Certificate or a CLIA Waiver to perform this procedure. Payment, however, is questionable and leaves us to perform this beneficial procedure on a cash only basis - at least for now. Thank you

  3. Default PRP inj
    My boss just sent me this as we are also trying to figure out what to bill for PRP injections(See article below). It says to AVOID 36514

    Orthopedic Coding Clinic: Pull the Plug on PRP Injection Denials Posted on 22. Jun, 2009 by Editor in Hot Coding Topics

    hide Google Search ResultsYou arrived here after searching for the following phrases:

    Click a phrase to jump to the first occurrence.

    Red cells, white cells & platelets
    Here's where 86999 comes in.

    If your orthopedist is performing platelet rich plasma (PRP) injections with surgical reconstructions and you're looking for a way to report this, you may be making your life more difficult than it should be. Most likely, you should consider this inherent to the surgical procedure.

    That's not what most coders and physicians want to hear. “This is currently a great challenge for our physicians who are performing this procedure with excellent outcomes — yet they are being told they should not be paid for it,” laments Gloria Caballero, director of finance at OED Orthopaedics in Warrenville, Ill.

    But take heart: In one situation, you might be able to get away with an unlisted procedure code to reflect the additional work.

    To minimize denials and save precious time, discover what PRP involves, what you should report, and what codes you should avoid.

    What Is PRP?

    In the past seven years, PRP has taken off in orthopedic medicine. These treatments focus on healing joints: ligaments, tendons, and cartilage. A primary problem is that there is little blood flow in the joint tissues compared with muscle tissues. PRP stimulates blood flow to the area which allows for the breakdown of unhealthy tissue and the creation of new, healthy tissue. Patients heal faster.

    If you're reading this, you're smart enough to get your COSC™ certification. Hurray! An specialty exam prep training camp is coming to a city near you!

    Benefit: The primary advantage of PRP is that the orthopedist places blood platelets involved in healing damaged connective tissue into the area — rather than wait for the body to do so on its own. By using one's own blood platelets, which the body quickly replaces, rejection is not an issue.

    “PRP addresses surgical healing and tendonitis,” says Connie Treonze, practice administrator for Associated Orthopedics in Union, N.J.

    “Our hand surgeons primarily do this procedure as a treatment for epicondylitis,” Caballero adds.

    “The problem is there is no code at this point that really fits what the physician performs,” Caballero says.

    Here's What to Do on Your Claim

    Example 1: The patient undergoes an orthopedic surgery. The orthopedic surgeon draws 60 cc of the patient's blood, which is then centrifuged for 15 minutes to separate PRP from the platelet-poor plasma. The surgeon injects the PRP into the operative site.

    Although you might want to reflect the surgeon's work with a code, you should consider the platelet instillation into the surgical site as part of the surgery. “In other words, you should not code for this,” says Lori Pierson, BS, RHIA, CPC, coding specialist for Promedica Physician Group in Sylvania, Ohio.

    You can find this advice in CPT Assistant November 2005, CPT Assistant March 2009, and ICD-9 Coding Clinic, Vol. 19, No. 2, 2nd Qtr 2002. The CPT advisors representing the College of American Pathologists and the American Society for Clinical Pathology second this instruction.

    Example 2: Suppose, however, the orthopedist is performing this procedure for epicondylitis, and it is the only procedure he performs.

    You should report the appropriate injection code (such as 20551, Injection[s]; single tendon origin/insertion). If the surgeon does the blood draw and platelet processing, you can report 86999 (Unlisted transfusion medicine procedure).

    Cross These Codes Off Your List

    Watch out: If vendors are advising you to use a slew of CPT codes, be wary. “I know there is a great controversy regarding the proper coding methodology for these procedures, and vendors may not always provide appropriate advice,” Caballero says. “It's up to practice coders to determine what to code and what not to.”

    For instance, you should not report 36513 (Therapeutic apheresis; for platelets) because the surgeon did not perform therapeutic apheresis. Also, cross out 86985 (Splitting of blood or blood products, each unit) as an option for describing the derivation of the platelets. Therefore, you shouldn't report 86940 (Hemolysins and agglutinins; auto, screen, each) either.

    Do not rely upon 20926 (Tissue grafts, other [e.g., paratenon, fat, dermis]), because blood is not a paratendon, fat, dermis, or tissue graft.

    You should also avoid codes 20552 (Injection[s]; single or multiple trigger points[s], 1 or 2 muscle[s]), 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]), 36514 (Therapeutic apheresis; for plasma pheresis), or 38230 (Bone marrow harvesting for transplantation). They do not describe a PRP injection from the patient's blood, drawn and centrifuged, and injected back into the involved anatomic site.

    Still unsure? Refer to your payers' guidelines, as they can offer recommendations as to what you shouldn't report. For example, First Coast Surgical Options, a Medicare carrier for Florida and Connecticut, addressed this pitfall in their Medicare Part B January 2007 update about “Vitagel,” another hemostasis product:

    “Recently, providers may have received instructions that may result in the incorrect billing of VITAGEL Surgical Hemostate using CPT code 20926. Hemo-stasis is considered to be an integral part of any surgical procedure. Therefore, VITAGEL Surgical Hemostat is not separately payable by the carrier and should not be billed using CPT code 20926.”

    © Orthopedic Coding Alert. Get 2 FREE SAMPLE ISSUES here.

    Tags: 20551, 20552, 20926, 36513, 36514, 86940, 86999, epicondylitis, orthopedic, platelet rich plasma injection, PRP, VITAGEL
    One Comment
    Dana Waegele

    04. Feb, 2010
    there is a new code released Jan 1, 2010 which will be effective July 1, 2010 for PRP injections 0232T published by the AMA. This will have final publication in the CPT 2011 Manuel however effective on July 1,2010

  4. #4
    St. Cloud, MN
    I've done some research on this topic as well and what we came down to is that we charge out the blood draw=36415, the spin/blood separation=86985, J3590 and specify on the HCFA that the J code is WBC and Plasma, no NDC number needed or available, and the injection code for site. So far, they have been paid and no rejections. I also agree that the apheresis codes should not be used from what I have found. (i don't have my CPT book with me, but believe that these are the correct codes.

  5. Default
    My podiatrist uses 20926 and 20550. We have yet to run into any problems. Hope that helps.

  6. Default PRP is coded 0232T
    Quote Originally Posted by banderson77 View Post
    My podiatrist uses 20926 and 20550. We have yet to run into any problems. Hope that helps.
    PRP should be billed with 0232T

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