How To Use CPT Code 36516

CPT 36516 describes the therapeutic apheresis procedure that involves extracorporeal immunoadsorption, selective adsorption, selective filtration, and plasma reinfusion. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 36516?

CPT 36516 is used to report the therapeutic apheresis procedure, which involves the extracorporeal treatment of blood outside the body. During this procedure, specific components of the blood are filtered and treated, and the remaining plasma and other blood components are returned to the patient. This code specifically includes extracorporeal immunoadsorption, selective adsorption, selective filtration, and plasma reinfusion.

2. Official Description

The official description of CPT code 36516 is: ‘Therapeutic apheresis; with extracorporeal immunoadsorption, selective adsorption or selective filtration and plasma reinfusion.’ This code should be reported with modifier 26 for professional evaluation.

3. Procedure

1. The patient is placed under sterile conditions.
2. An extracorporeal machine is used to connect the patient’s blood flow.
3. The machine separates specific components of the blood.
4. The separated components are treated and filtered outside the body.
5. The treated plasma and other blood components are returned to the patient.

4. Qualifying circumstances

CPT 36516 is used for patients with serious immune disorders, such as hemolytic uremic syndrome, idiopathic thrombocytopenic purpura, life-threatening systemic lupus erythematosus, severe rheumatoid arthritis, myasthenia gravis, and therapy-resistant pemphigus vulgaris. The procedure is performed by a physician and involves the extracorporeal treatment of blood outside the body for immune complexes, filtration of specific components, and return of the plasma to the patient.

5. When to use CPT code 36516

CPT code 36516 should be used when performing therapeutic apheresis with extracorporeal immunoadsorption, selective adsorption, selective filtration, and plasma reinfusion. It is important to ensure that the procedure meets the qualifying circumstances mentioned above. This code should not be used for other types of apheresis procedures or when the specific components mentioned are not involved.

6. Documentation requirements

To support a claim for CPT 36516, the documentation should include:

• Details of the patient’s immune disorder and the need for therapeutic apheresis
• Description of the specific components filtered and treated
• Date and duration of the procedure
• Any additional treatments or infusions administered during the procedure
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 36516, ensure that the procedure meets the requirements mentioned in the official description. Modifier 26 should be used for professional evaluation. It is important to follow the specific guidelines provided by the payer regarding the reporting of this code. Additionally, be aware of other codes that may be relevant to the procedure and follow any specific instructions or modifiers required for accurate billing.

8. Historical information

CPT 36516 was added to the Current Procedural Terminology system on January 1, 2003. The code was later updated on January 1, 2018, to include extracorporeal selective adsorption or selective filtration and plasma reinfusion.

9. Examples

1. A patient with severe rheumatoid arthritis undergoing therapeutic apheresis with extracorporeal immunoadsorption, selective adsorption, selective filtration, and plasma reinfusion.
2. A patient with hemolytic uremic syndrome receiving therapeutic apheresis with extracorporeal immunoadsorption, selective adsorption, selective filtration, and plasma reinfusion.
3. A patient with idiopathic thrombocytopenic purpura undergoing therapeutic apheresis with extracorporeal immunoadsorption, selective adsorption, selective filtration, and plasma reinfusion.
4. A patient with life-threatening systemic lupus erythematosus receiving therapeutic apheresis with extracorporeal immunoadsorption, selective adsorption, selective filtration, and plasma reinfusion.
5. A patient with myasthenia gravis undergoing therapeutic apheresis with extracorporeal immunoadsorption, selective adsorption, selective filtration, and plasma reinfusion.
6. A patient with therapy-resistant pemphigus vulgaris receiving therapeutic apheresis with extracorporeal immunoadsorption, selective adsorption, selective filtration, and plasma reinfusion.
7. A patient with severe rheumatoid arthritis undergoing therapeutic apheresis with extracorporeal immunoadsorption, selective adsorption, selective filtration, and plasma reinfusion.
8. A patient with hemolytic uremic syndrome receiving therapeutic apheresis with extracorporeal immunoadsorption, selective adsorption, selective filtration, and plasma reinfusion.
9. A patient with idiopathic thrombocytopenic purpura undergoing therapeutic apheresis with extracorporeal immunoadsorption, selective adsorption, selective filtration, and plasma reinfusion.
10. A patient with life-threatening systemic lupus erythematosus receiving therapeutic apheresis with extracorporeal immunoadsorption, selective adsorption, selective filtration, and plasma reinfusion.