12/29/2023 0 Comments Autologous stem cell transplant icd 10![]() ![]() Injection, interferon alfacon-1, recombinant, 1 microgram HCPCS codes covered if selection criteria are met:īone marrow or blood-derived stem-cells (peripheral or umbilical), allogeneic or autologous, harvesting, transplantation, and related complications including: pheresis and cell preparation/storage marrow ablative therapy drugs, supplies, hospitalization with outpatient follow-up medical/surgical, diagnostic, emergency, and rehabilitative services and the number of days of pre- and post-transplant care in the global definition Total, en bloc for extensive disease, in conjunction with other procedure (List in addition to code for primary procedure)īone marrow or stem cell services/proceduresīlood smear, peripheral, interpretation by physician with written report Hematopoietic progenitor cell (HPC) allogeneic transplantation per donor Codes requiring a 7th character are represented by "+":ĬPT codes covered if selection criteria are met:īone marrow harvesting for transplantation allogeneic Information in the below has been added for clarification purposes. Table: CPT Codes / HCPCS Codes / ICD-10 Codes Code In the absence of an institution's selection criteria, Aetna considers allogeneic hematopoietic cell transplantation medically necessary for congenital dyserythropoietic anemia when member is transfusion-dependent and has failed interferon alfa, and splenectomy.Īetna considers repeat allogeneic stem cell transplantation medically necessary for primary graft failure, failure to engraft or rejection in severe aplastic anemia, Diamond-Blackfan anemia, Fanconi's anemia, paroxysmal nocturnal hemoglobinuria, and pure red cell aplasia.Īetna considers autologous hematopoietic cell transplantation experimental and investigational for the treatment of severe aplastic anemia, Diamond-Blackfan anemia, Fanconi's anemia, paroxysmal nocturnal hemoglobinuria, and pure red cell aplasia because its effectiveness for these indications has not been established. In the absence of an institution's selection criteria, Aetna considers allogeneic hematopoietic cell transplantation medically necessary in persons with paroxysmal nocturnal hemoglobinuria with ongoing transfusion requirements and a suitable human leukocyte antigen (HLA)-matched donor. In the absence of an institution's selection criteria, Aetna considers allogeneic hematopoietic cell transplantation medically necessary for Fanconi's anemia in persons with severe bone marrow failure, myelodysplastic syndrome, or acute myelogenous leukemia. In the absence of an institution's selection criteria, Aetna considers allogeneic hematopoietic cell transplantation medically necessary for the treatment of Diamond-Blackfan anemia in persons who are refractory to corticosteroids. Reticulocyte count less than 1 % or less than 20 x 10 9/L (corrected for hematocrit).Bone marrow cellularity less than 25 % (markedly hypocellular) and.In the absence of a institution's selection criteria, Aetna considers allogeneic hematopoietic cell transplantation medically necessary for the treatment of pure red cell aplasia when the member has the following features. Untransfused platelet count less than 20 x 10 9 /L.Neutrophil count less than 0.5 x 10 9/L.Bone marrow cellularity less than 25 % (markedly hypocellular).In the absence of a institution's selection criteria, Aetna considers allogeneic hematopoietic cell transplantation medically necessary for the treatment of severe aplastic anemia when the member has at least 3 of the 4 following features: INJURY, POISONING AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES (S00-T88)Ĭontains Chapter Name (for DX) or Section Name (for PCS).Ĭontains Block (for DX) or Body System (for PCS) Code.ĬOMPLICATIONS OF SURGICAL AND MEDICAL CARE, NOT ELSEWHERE CLASSIFIEDĬontains Block (for DX) or Body System (for PCS) Name.Number: 0627 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background ReferencesĪetna considers allogeneic hematopoietic cell transplantation medically necessary for the treatment of severe aplastic anemia, Diamond-Blackfan anemia, Fanconi's anemia, paroxysmal nocturnal hemoglobinuria, and pure red cell aplasia when members meet the transplanting institution's selection criteria. THE CODE IS VALID FOR SUBMISSION ON A UB04Īdditional note, saying whether this code is valid for submission on a UB04Ĭontains Chapter (for DX) or Section (for PCS) Code. Specifies the type of code (Diagnosis / Procedure)įield value is saying whether this code is valid for submission on a UB04 The ICD-10 procedure coding system uses 7 alpha or numeric digits Note: dots are not included.ĭiagnosis coding under this system uses 3–7 alpha and numeric digits Defines ICD code revision (“10th Revision”) ![]()
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