Catherine Posted Sat 22nd of June, 2013 15:14:24 PM
Patient comes in for photopheresis. Should you bill for the initial insertion of needles, catheter, etc and follow up for different days with a J-code? What if '36522' is not on fee schedule?
SuperCoder Answered Mon 24th of June, 2013 12:18:38 PM
It looks like 36522 is the right code for outpatient. If it isn't on the fee schedule for the particular payer, it may be a contract issue. The service is covered by Medicare.
Extracorporeal photopheresis is a second-line treatment for a variety of oncological and autoimmune disorders that is performed in the hospital inpatient, hospital outpatient, and Critical Access Hospital (CAH) settings.
The Centers for Medicare & Medicaid Services (CMS) has determined that extracorporeal photopheresis is reasonable and necessary under §1862(a)(1)(A) of the Social Security Act (the Act) for the following nationally covered indications. Medical documentation must support the inclusion of the appropriate diagnosis code for one of the following conditions on the claim:
Palliative treatment of skin manifestations of cutaneous T-cell lymphoma that has not responded to other therapy;
Patients with acute cardiac allograft rejection whose disease is refractory to standard immunosuppressive drug treatment; and
Patients with chronic graft versus host disease whose disease is refractory to standard immunosuppressive drug treatment.
For the treatment of bronchiolitis obliterans syndrome (BOS) following lung allograft transplantation only when extracorporeal photopheresis is provided under a clinical research study that meets certain clinical research study requirements outlined in the National Coverage Determination (NCD).