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The following article is written by Cristina Bentin, CCS-P, CPC-H, CMA, president of Coding Compliance Management.
In May 2012, the American Medical Association (AMA) issued directives regarding the reporting of Category III code 0232T, (injection[s], platelet rich plasma, any site, including image guidance, harvesting and preparation when performed) when performed during an orthopedic procedure.
Recall, past directives from many associations and societies were that the placement/injection of the cells into the operative site is an inclusive component of the operative procedure performed and not separately reported. Past directives indicated Category III code 0232T could only be reported if the PRP injection is performed on a nonsurgical site or when performed unrelated to the surgical site. CPT instructed and still instructs not to report Category III code 0232T in conjunction with 20550, 20551, 20926, 76942, 77002, 77012, 77021 and 86965.
As of this writing, the AMA has issued reporting directives (CPT Assistant May 2012 p11-12) which currently allow for the separate reporting of 0232T in addition to the definitive operative procedure.
AMA directives provide an example of an injection of PRP into the operative site of a tibial fracture nonunion repair reiterating the separate reporting of 0232T for the injection into the operative site of the platelet rich plasma in addition to the definitive tibial fracture nonunion repair code when documented/described/performed and not considered bundled/inclusive per carrier edits/bundling policies.
The American Medical Association still reiterates the following inclusions, "…Code 0232T also includes any imaging guidance used for harvesting and the preparation for injection. Therefore, it is not appropriate to report code 86999, Unlisted transfusion medicine procedure, for obtaining and centrifuging the blood drawn or to report code 86985, Splitting of blood or blood products, each unit, to describe the derivation of the platelets. In addition, none of the codes specific to aspiration or harvesting of bone marrow (eg, 38220, 38230, etc.) would be appropriate to report when the procedure is being performed to obtain platelet rich plasma."
As of this writing, The American Academy of Orthopaedic Surgeons maintains its position. The AAOS maintains that Category III 0232T is to be used only when PRP is performed in a complete separate patient encounter from a surgical procedure. PRP should not be reported separately when performed as part of a larger repair whether traumatic or nontraumatic or reconstruction procedure.
Keep in mind, CPT coding guidelines may differ from individual commercial carrier and Medicare guidelines. Reporting, documentation, and provider requirements are determined and must be verified with each individual carrier whether commercial versus MAC. In addition, facilities should continue to monitor associations, specialty societies, and carrier directives for reporting modifications.
To contact Cristina Bentin (cristina@ccmpro.com) and learn more about Coding Compliance Management, visit www.ccmpro.com.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.