Q&A: How do we report stem cell acquisition?
Q: We started providing allogenic hematopoietic stem cell transplants on an outpatient basis for some of our patients. Until just recently, none of them were Medicare patients, but now we have some patients that meet the physician-established criteria for the transplant being done as an outpatient. We know that Medicare doesn’t separately pay for the donor acquisition services so we can’t bill them separately. How do we include this on the claim to ensure that the cost of all components of this service are reported?
A: Stakeholders discussed concerns about reporting these services on an outpatient claim to ensure that the specific and unique costs were identified on an outpatient claim during OPPS rulemaking last year.
CMS discussed in detail in the 2017 OPPS final rule that this is a very unique situation and they are making special accommodation by establishing a new comprehensive APC (C-APC) for this service. CPT code 38240 (hematopoietic progenitor cell [HPC]; allogeneic transplantation per donor) is assigned to new C-APC 5244.
In order to ensure the cost of the services is recognized on the outpatient claims, hospitals are required to report revenue code 0815 when billing the donor acquisition services associated with the transplantation.
CMS is implementing a claim edit that requires both CPT code 38240 and revenue code 0815 for the donor acquisition services to be reported on the outpatient claim. Revenue code 0815 is to be used in this scenario, replacing revenue code 0819. CMS will update the Medicare Claims Processing Manual (Pub. 100-04, Chapter 4, Section 231.11 and Chapter 3, section 90.3.1) to reflect the new billing guidelines for this service.
Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.
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