Physician Coding & Reimbursement
Platelet-rich plasma – A Category III code (0232T), introduced in July 2010 for the administration of platelet-rich plasma (PRP), is listed as a new Category III code in 2011. To coincide with the introduction of the new code, CPT added related guideline instructions.
Two CPT codes (20551—Injection[s]; single tendon origin/insertion—and 20926—Tissue grafts, other [eg, paratenon, fat, dermis]) reference the PRP Category III code for the work associated with the injections. Because this is an all-inclusive code, PRP used as an adjunct to surgical procedures is not separately reportable. The patient’s insurance benefits should be verified so surgeons fully understand the payer’s policies related to this procedure.
Information provided by AAOS
Pre-injection guidelines
The patient should be aware of and compliant with the following guidelines:
- No corticosteroids for 2 to 3 weeks before the procedure.
- Discontinue nonsteroidal anti-inflammatory drugs (NSAIDs). Although no formal recommendations have been made in this area, our practice suggests that the patient discontinue taking NSAIDs a minimum of 1 week before the procedure.
- No anticoagulation use 5 days before the procedure.
- Increase fluid intake in the 24 hours preceding the procedure.
- Anti-anxiety medication may be required for certain patients.
AAOS Site Santos F. Martinez, MD, is affiliated with the Campbell Clinic. He can be reached at sfmartinez@campbellclinic.com
Contraindications
The following conditions should be considered as contraindications for PRP injection: hematologic blood dyscrasias with platelet dysfunction; septicemia or fever; cutaneous infections in the area to be injected; anemia (hemoglobin less than 10 deciliters; malignancy, particularly with hematologic or bony involvement; allergy to bovine products if bovine thrombus is to be used.
AAOS Site Santos F. Martinez, MD, is affiliated with the Campbell Clinic. He can be reached at sfmartinez@campbellclinic.com
Procedure
The procedure is simple. With sterile technique, obtain appropriate amount of venous blood and transfer it to the centrifuge. After processing is completed, extract the PRP from the centrifuge according to the manufacturer’s instructions. Cleanse the patient’s skin around the injection site; if desired, use towels or drapes to create an aseptic field. Administer a local anesthetic if necessary. With real-time image guidance (computed tomography, fluoroscopy, or ultrasound) and sterile technique, inject the PRP into the appropriate area; apply dressing or bandage to protect needle entry site.
Check out this in depth sample surgical protocol for prp injection treatment provided by Crane Clinic Sports Medicine(Missouri).
AAOS Site Santos F. Martinez, MD, is affiliated with the Campbell Clinic. He can be reached at sfmartinez@campbellclinic.com
Complications
Reported adverse effects are not different from those of normal venipuncture or injections at the same body locations. PRP injections, however, are frequently more painful than other injections due to the viscosity of the solution.
AAOS Site Santos F. Martinez, MD, is affiliated with the Campbell Clinic. He can be reached at sfmartinez@campbellclinic.com
