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Thread: Platlet rich plasma injection-help asap

  1. #1

    Default Platlet rich plasma injection-help asap

    Can someone help me with this coding scenario? Physcian office bills cpt 20926 for these. According to CPT book it states for injection of platelet rich plasma to use 0232T. If it is a Medicare patient, they only pay $18.55. Not worth doing in the ASC if that is the case. Also how does commercial insurance companies pay for these?

    I appreciate any info.
    Vickie Mounce


    PREOPERATIVE DIAGNOSIS: Chronic plantar fasciitis, right foot.

    POSTOPERATIVE DIAGNOSIS: Chronic plantar fasciitis, right foot.

    PROCEDURE: PRP injection, right foot.


    PROCEDURE IN DETAIL: The patient was brought to the preoperative holding area where IV access was initiated. The procedure was once again explained in detail to the patient and she voiced no concerns. Her history and physical were reviewed and no changes had been made since her previous visit. The patient was then transported to the operating room and left on the stretcher. Approximately 24-30 mL of the patient’s blood was drawn and prepared according to PRP guidelines. Mild MAC anesthesia was initiated and an ankle block was performed about the right ankle utilizing 20 mL of 0.5% Marcaine plain. Once adequate anesthesia was obtained, 4 mL of prepared PRP was injected into the plantar aspect of the right heel in a fanned fashion at the point of maximum tenderness, which was palpated and marked prior to the initiation of anesthesia.

    The foot was cleansed after a prep was performed utilizing Betadine. A band-aid was applied. The patient was then transferred to the recovery room with vital signs stable and vascular status intact. She tolerated the injection well. She was given all home-going instructions as well as Tramadol for pain management. A postoperative shoe and crutches were also given to the patient. She will follow up in my office in Corbin within two weeks.

  2. #2

    Default

    Do not report with (20550-20551, 20600-20610, 20926, 76942, 77002, 77012, 77021, 86965) as instructed in the CPT book.

    http://www.aaos.org/news/aaosnow/aug10/managing9.asp

    Sorry, usually done w/ repair and do not bill separate.
    Last edited by Jamie Dezenzo; 11-01-2011 at 11:32 AM.

  3. #3
    Join Date
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    Tacoma, WA
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    1,086

    Default

    Quote Originally Posted by vmounce View Post
    Can someone help me with this coding scenario? Physcian office bills cpt 20926 for these. According to CPT book it states for injection of platelet rich plasma to use 0232T. If it is a Medicare patient, they only pay $18.55. Not worth doing in the ASC if that is the case. Also how does commercial insurance companies pay for these?

    I appreciate any info.
    Vickie Mounce


    PREOPERATIVE DIAGNOSIS: Chronic plantar fasciitis, right foot.

    POSTOPERATIVE DIAGNOSIS: Chronic plantar fasciitis, right foot.

    PROCEDURE: PRP injection, right foot.


    PROCEDURE IN DETAIL: The patient was brought to the preoperative holding area where IV access was initiated. The procedure was once again explained in detail to the patient and she voiced no concerns. Her history and physical were reviewed and no changes had been made since her previous visit. The patient was then transported to the operating room and left on the stretcher. Approximately 24-30 mL of the patient’s blood was drawn and prepared according to PRP guidelines. Mild MAC anesthesia was initiated and an ankle block was performed about the right ankle utilizing 20 mL of 0.5% Marcaine plain. Once adequate anesthesia was obtained, 4 mL of prepared PRP was injected into the plantar aspect of the right heel in a fanned fashion at the point of maximum tenderness, which was palpated and marked prior to the initiation of anesthesia.

    The foot was cleansed after a prep was performed utilizing Betadine. A band-aid was applied. The patient was then transferred to the recovery room with vital signs stable and vascular status intact. She tolerated the injection well. She was given all home-going instructions as well as Tramadol for pain management. A postoperative shoe and crutches were also given to the patient. She will follow up in my office in Corbin within two weeks.
    From the procedure description, the 0232T is the correct code for what was done. How can the physician office be billing 20926? The description of that procedure is for a tissue graft not an injection! The information does indicate that this is carrier priced, so perhaps it is time to contact someone at your Medicare carrier's provider relations office and explain what is involved in the procedure so you get better reimbursement. That is what the temporary codes are all about...get new technology out there and getting the pricing of the procedure adequate for the work involved.
    Arlene J. Smith, CPC, CEMC, COBGC
    AAPC Tacoma WA Chapter

    President 2015
    Past-President 2013 and 2011
    President-Elect 2010
    Member Relations 2008
    AAPC NAB 2007-2009

  4. #4

    Default

    Arlene,

    I appreciate the reply. It is sometimes difficult to get answers. I wanted to be sure the information was correct before taking to the business director.

    Vickie Mounce

  5. #5

    Default Plasma rich platelet heel injection

    I still have no replies on below. I am sending back through in hopes someone knows something about the Plasma Rich Platelets heel injections. See below:

    I have information from someone that works with a harvesting company. He stated that I would use cpt 36513 for the Platlet rich plasma injections of the heel. Does anyone know anything about this?

    Thanks, Vickie
    Last edited by vmounce; 11-14-2011 at 06:29 AM. Reason: no replies on last comment

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