How To Use CPT Code 0481T

CPT 0481T describes the injection of autologous white blood cell concentrate, also known as autologous protein solution, into a patient. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0481T?

CPT 0481T can be used to describe the injection of autologous white blood cell concentrate, which is a concentrated protein solution derived from the patient’s own white blood cells. This code is used when the provider performs the injection, including any necessary imaging guidance, after harvesting and preparing the white blood cells.

2. Official Description

The official description of CPT code 0481T is: ‘Injection(s), autologous white blood cell concentrate (autologous protein solution), any site, including image guidance, harvesting and preparation, when performed.’

3. Procedure

1. The provider begins by prepping and anesthetizing the patient.
2. Using a drill-like motion, the provider inserts a needle into the bone marrow cavity, typically in the sternum, iliac crest, or ribs. Image guidance may be used to assist with the placement of the needle.
3. The provider then extracts a sample of the patient’s bone marrow.
4. The harvested bone marrow is processed to produce a concentrated white blood cell solution.
5. The provider injects the autologous white blood cell concentrate back into the patient.
6. Finally, the provider dresses the wound with a pressure dressing.

4. Qualifying circumstances

CPT 0481T is appropriate for patients who require the injection of autologous white blood cell concentrate. This procedure is commonly performed for therapeutic purposes, such as promoting tissue healing or reducing inflammation. It is important to note that CPT 0481T should not be reported in conjunction with certain other codes, as specified in the notes.

5. When to use CPT code 0481T

CPT code 0481T should be used when the provider performs the injection of autologous white blood cell concentrate, including the harvesting and preparation of the white blood cells. This code should not be reported with certain other codes, as indicated in the notes.

6. Documentation requirements

To support a claim for CPT 0481T, the provider must document the following information:

• The medical necessity for the injection of autologous white blood cell concentrate
• The specific site of the injection
• Whether image guidance was used for the harvesting and/or injection
• The date of the procedure
• Any complications or adverse reactions
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 0481T, ensure that the injection of autologous white blood cell concentrate, including the harvesting and preparation, is performed by the provider. It is important to follow the guidelines and not report this code with certain other codes, as specified in the notes. Additionally, consider the location of the injection, as it may impact how the procedure is coded.

8. Historical information

CPT 0481T was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition.

9. Examples

1. A provider injects autologous white blood cell concentrate into a patient’s knee joint to promote tissue healing.
2. Using image guidance, a provider performs an injection of autologous white blood cell concentrate into a patient’s shoulder to reduce inflammation.
3. A provider administers an autologous white blood cell concentrate injection into a patient’s hip joint to alleviate pain and promote healing.
4. After harvesting and preparing autologous white blood cell concentrate, a provider injects it into a patient’s ankle to aid in tissue regeneration.
5. Using image guidance, a provider performs an injection of autologous white blood cell concentrate into a patient’s elbow to promote healing of a tendon injury.
6. A provider administers an autologous white blood cell concentrate injection into a patient’s wrist to reduce inflammation and promote tissue repair.
7. After harvesting and preparing autologous white blood cell concentrate, a provider injects it into a patient’s spine to aid in the healing of a disc herniation.
8. Using image guidance, a provider performs an injection of autologous white blood cell concentrate into a patient’s hip joint to alleviate pain and promote healing.
9. A provider administers an autologous white blood cell concentrate injection into a patient’s shoulder to reduce inflammation and promote tissue repair.
10. After harvesting and preparing autologous white blood cell concentrate, a provider injects it into a patient’s ankle to aid in the healing of a ligament injury.