Get ready to track down some donor details before coding bone marrow harvesting. CPT 2012 needs to know.
Concerning 2011 dates of service, in case someone had asked, "Does coding for bone marrow harvesting differ based on whether the patient donates the cells or whether another person donates the cells?" the answer would have been, "No."
However a code revision and a code adding in CPT 2012 change that answer to "Yes," effective Jan. 1, 2012.
Consider this revision of 38230:
As 38230 is specific to allogeneic harvest in CPT 2012, CPT® similarly created a code for autologous harvest: 38232, Bone marrow harvesting for transplantation; autologous.
Match the CPT Codes to the Procedures
To apply the CPT codes correctly, keep in mind that "auto" means "self" and "allo" means "other."
For bone marrow transplant medical coding, "autologous" specifies the cells are from the same individual.
Thus autologous means a single patient donates the cells (38232) and then receives those cells back at a later date and through a distinctly reportable service (38241, Bone marrow or blood-derived peripheral stem cell transplantation; autologous).
Allogeneic means the cells are from someone other than the patient. The technical definition of allogeneic is "genetically different but from the same species. For allogeneic harvesting (38230), the donor may be either related or unrelated to the patient. Later, when the patient receives the cells donated from a different individual, you should report 38240 (Bone marrow or blood-derived peripheral stem cell transplantation; allogeneic) for the transplant.
Straight from the source: Medicare addresses stem cell transplantation in Claims Processing Manual 100-04, chapter 3, section 90.3. (“Stem cell transplantation is a process in which stem cells are harvested from either a patient's or donor's bone marrow or peripheral blood for intravenous infusion. Autologous stem cell transplants must be used to effect hematopoietic reconstitution following severely myelotoxic doses of chemotherapy and/or radiotherapy used to treat various malignancies. Allogeneic stem cell transplant may also be used to restore function in recipients having an inherited or acquired deficiency or defect. Bone marrow and peripheral blood stem cell transplantation is a process which includes mobilization, harvesting, and transplant of bone marrow or peripheral blood stem cells and the administration of high dose chemotherapy or radiotherapy prior to the actual transplant".)
Capture New Opportunity to Code Follow-Up
Wording changes aren't just the only news you require to know for stem cell harvest coding. The number of global days has a revision for CPT 2012, as well.
In 2011, Medicare gave 38230 a 10-day global period. That meant that E/M services on the day of the procedure and during the 10-day postoperative period normally weren't payable when the visit was related to the outcome of the procedure, as defined by the global surgical package rules.
As per the 2012 Medicare Physician Fee Schedule (Final, in comment period), CPT codes 38230 and 38232 have a global period of 000 for 2012. Reason: "These services rarely require overnight hospitalization and physician follow-up in the days following the procedure."
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