Forum - Questions & Answers

May 12th, 2010 - jmorrow

Platelet Rich Plasma injections in a clinic setting

I was wondering what people are using to code Platelet Rich Plasma injections in a clinic setting? My research is showing that patient's with private insurance are getting pre-authorization and partial reimbursement, but nobody is staing what codes they are using to get this reimbursement. It would be great great to share this information.

Thanks -

Jack Morrow
Chief Perfusionist
Perfusion
Stormont-Vail HealthCare
1500 Sw 10th
Topeka, KS 66604
785-354-5624

May 12th, 2010 - nmaguire   2,606 

PRP 2010, July Category III

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 and effective six months later. Here are two newly released Category III codes that will take effect on July 1.
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

When implemented, it is important to verify with your Medicare and commercial carriers as to individual reporting and reimbursement policies for the PRP procedure.



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