When a provider performs a PRP injection in the office and the injection is into the elbow joint what is the appropriate coding? This is for CA Workers' Comp. I keep coming up with 20610. Any assistance is appreciated. Thanks.
If you do a search for PRP then you get a few different posts regarding this as this question has been asked before.
NEW Category III code for PRP injections effective 7/1/10:
0232T (injection[s], platelet rich plasma, any tissue, including image guidance, harvesting and preparation when performed)
The injection for PRP or PDGF should be reported with the new category III code that went into effect 7/1/2010. The price should reflect the work involved. If the provider obtained the plasma, prepared it and injected it then the price should reflect that. If the provider only injected the plasma (prepared by someone else) then the price should only reflect the injection. If the PRP injection was done during a surgical procedure then no additional reimbursement should be requested as it would be included in the surgical procedures.
New Category III codes for orthopedic procedures and pain management injections start July 1 Category III codes are a temporary set of codes for emerging technologies, procedures and services that are released on a semi-annual basis. Here is the newly released Category III code for PRP injections that will take effect on July 1, 2010.
Platelet rich plasma injections. PRP injections involve collecting a patient’s blood, separating out the platelet rich portion, containing the growth factors and injecting it back into the injury site, should be reported as 0232T (injection[s], platelet rich plasma, any tissue, including image guidance, harvesting and preparation when performed). However, CPT instructs not to report 0232T in conjunction with 20550, 20551, 20926, 76942, 77002, 77012, 77021 and 86965.
The following components are included in the PRP and cannot be billed separately. 20550-20551 - tendon and tendon sheath injection 20926 - tissue graft 76942, 77002, 77012, 77021 - imaging 86965 - pooling of platelets or other blood products
See these two links for more info: http://www.ama-assn.org/ama1/pub/upload/mm/362/cptcat3codes.pdf
The AAOS also posted an article in their August 2010 AAOS online now publication which you can read here: http://www.aaos.org/news/aaosnow/aug10/managing9.asp
Article by AAOS on PRP Injections:
PRP gets CPT Category III code
By Matthew Twetten
On July 1, 2010, the American Medical Association (AMA) Current Procedural Terminology (CPT) introduced a new category III (new technology) code for the performance of platelet rich plasma (PRP) injection procedures. The specific wording of the code follows:
“0232T—Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed (Do not report 0232T in conjunction with 20550, 20551, 20600-20610, 20926, 76942, 77002, 77012, 77021, 86965.)”
The new code must be used by orthopaedic surgeons who perform PRP injections in reporting performance of the procedure in lieu of whatever single code, or combination of codes, they had been using previously. The new code cannot be billed in conjunction with other injection procedure codes such as 20550, 20551, 20600, 20605, or 20610.
The new code includes the harvesting of the blood, spinning of the blood, and injection of the remaining plasma. None of these steps can be billed any longer nor can orthopaedic surgeons use these other codes in place of 0232T. Under CPT rules, physicians must use the most accurate code available, which, for PRP injections, is now the new category III code.
The new code is to be used only when PRP is performed in a complete separate patient encounter from a surgical procedure.
Any time a physician uses PRP as part of a larger reconstruction or repair (traumatic or nontraumatic) procedure, it is not separately billable.
Unlike Category I CPT surgical procedure codes, Category III codes do not have an assigned Medicare value and are therefore priced by regional carriers. Physicians will need to estimate the work involved in providing the service.