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How to bill autologous stem cell treatment

Tsai Posted Wed 12th of June, 2019 14:44:20 PM
One of our patient was authorized for autologous (Fat harvesting) stem cell treatment ( to her lumbar spine L4 and L5 with ICD 10 code of M54.16 ) in our office. The whole processing are as followings: Procedure Note for Stem Cell Harvest: After oral medication sedation, the patient was place supine. The entire abdomen was exposed for the procedure and was sterilized with Betadine followed by Alcohol and the chest and the pelvis areas were covered with sterile sheaths. Three small holes were made with sharp scalpel blade 11 after the application of intradermal injection of 1% Lidocaine, one below the umbilicus and the other two at bilateral lower abdomen. 25ml of 1:1200,000 epinephrine and 0.5% Bupivacaine and 1%Lidocaine 50ml in 500ml normal saline was infiltrated into the subcutaneous fatty layer of the entire abdomen. Waited for 10 minutes, the fat harvest was started using a special tubing to abstract the fat from the abdominal wall. Total of 100 ml of fatty tissue particles with injected liquid was obtained and appropriately placed to be sent to the stem cell lab (FDA certified) for processing.Procedure Note for Stem Cell Treatment: After the arrival of the prepared stem cell fluid for IV infusion and local injection, the patient received slow intravenous infusion of stem cell fluid in two hours. The small syringe of stem cell preparation was the injected into the epidural space using 18-gauge spinal needle blindly between L4 and L5. The patient tolerated the procedure very well. I want to know how to bill this service to insurance.
SuperCoder Answered Thu 13th of June, 2019 10:14:34 AM

Hi,

 

Thanks for your question.

 

As per provided documentation, it is appropriate to report code S2150 (Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or autologous, harvesting, transplantation, and related complications; including: pheresis and cell preparation/storage; marrow ablative therapy; drugs, supplies, hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency, and rehabilitative services; and the number of days of pre-and post-transplant care in the global definition}.

 

Note: Use S codes to represent drugs, services, and supplies. Private sector payers and Medicaid may require use of these codes to implement policies, programs, or claims processing and to meet the payer’s particular needs. These codes are not payable by Medicare.

 

Please feel free to write if you have any question.

 

Thanks

Tsai Posted Mon 17th of June, 2019 10:02:50 AM
Thank you for your replying. This is autologous (Fat harvesting) stem cell treatment, not the Bone marrow or blood-derived stem cells as you mentioned. The answer you described is very general even I could find such answer through other website. Could you be kind enough to provide more specific answer to this case?
SuperCoder Answered Tue 18th of June, 2019 08:20:29 AM

Hi,

 

Since we do not have a CPT code for this procedure, we need to select multiple codes. For harvesting of subcutaneous fat, you may report an unlisted code 17999 (Unlisted procedure, skin, mucous membrane and subcutaneous tissue).

 

For injection of harvested fat into the lumbar area, you may report code 62322 (Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance).

 
Hope this helps.
 
Thanks.
 
Tsai Posted Tue 18th of June, 2019 14:03:11 PM
Thank you for your help. While we did stem cell injection to her lumbar spine, we did Intravenous infusion her stem cell for her. Do you know what CTP code for infusion and should I add this code on as well, any modifier ? Thanks again.
Tsai Posted Tue 18th of June, 2019 14:05:09 PM
To my same question of the stem cell treatment, how to find the fee schedule to CPT code 17999 and 62322 ? Thank you.
SuperCoder Answered Wed 19th of June, 2019 09:13:56 AM

Hi,

 

For Intravenous infusion, code 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour) may be reported. But please be informed that intravenous infusion is always inclusive in the main procedure. Moreover, there is CCI edit between codes 96365 and 62322.

 

Fee can be found in the fee schedule as per the place of service. Example, if place of service is physician’s office, then you may find fee schedule in MPFS (Medicare Physician Fee Schedule). If you have subscription of SuperCoder.com, you can search your code in the search box and you will find all the fee schedules on your screen.

 

Code 17999 is an unlisted code and carriers price the unlisted codes. Carriers will establish RVUs and payment amounts for these services, generally on an individual case basis following review of documentation such as an operative report. You should give reference of a CPT code that describes similar (not exactly) procedure.

 

Hope this helps. Please feel free to write if you have any question.

 

Thanks

Tsai Posted Wed 19th of June, 2019 15:28:22 PM
Thank you. I don't understand what is "there is CCI edit between codes 96365 and 62322".
SuperCoder Answered Thu 20th of June, 2019 03:59:35 AM

"There is CCI edit between codes 96365 and 62322" means that there is bundling between these two codes. It is given by CMS. 

 
It means one procedure is part of another procedure and you cannot report both the procedures together.
 
 
Hope this helps.
 
 
Thanks
Tsai Posted Mon 24th of June, 2019 14:39:33 PM
Thank you for your help.
SuperCoder Answered Tue 25th of June, 2019 01:51:01 AM

Thank you, happy to help.

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