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Correct coding for PRP Injection

  1. #1
    Default Correct coding for PRP Injection
    Clearnace Sale
    Help!! We have an Ortho group that is billing a 90926 Tissue grafts, other (eg, paratenon, fat, dermis) when they do a PRP (Platelet Rich Plasma) in the office as a joint injection. I know this isn't the correct code and when doing research on the internet, there are numerous different responses with not one being consistant. The most common response that I have found is to bill the for the appropriate injection code and IF the physician does the blood draw and platelet processing, then reporting 86999 (unlisted transfusion medicine procedure).

    Can anyone advise, please????

    Thank You

    Heather MacPherson, LPN, CPC, CPC-H

  2. #2
    North Carolina
    I think you meant 20926...and I feel your pain. Coding this procedure with accurate information has been cumbersome!

    6-1-2009 Orthopedic Pink Sheet...(excerpt)

    CPT continues to advise that "it would not be appropriate to report the tissue graft 20926, nor the apheresis codes 36513 or 36514 or 38230 to describe platelet rich plasma injection from the patient's blood, having been drawn and centrifuged, and injected into the anatomic site involved." Nor may you use 24357 to report a PRP injection.

    CPT also states that "it is not appropriate to report code 86985, Splitting of blood or blood products, each unit, to describe the derivation of the platelets. Therefore, it is not appropriate to report code 86940."

    The CPT advisors state that "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."

    Of course...I have seen some dispute these codes, also.

    The good news is that there is a new code coming out 7-1-2010


    ●0232T Injection(s), platelet rich plasma, any tissue, including image guidance, harvesting and preparation when performed:

    (Do not report 0232T in conjunction with 20550, 20551, 20926, 76942, 77002, 77012, 77021, 86965)
    Rebecca CPC, CPMA, CEMC

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  3. #3
    THANKS Rebecca

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