Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin DL39434 . The CMS National Coverage Determination (NCD 110.23) for Stem Cell Transplantation describes nationally covered indications for stem cell transplant, the details of which will not be repeated within this article. This article describes additional locally covered indications for stem cell transplant. The following evaluation is recommended to determine if the patient is an appropriate candidate for the procedure. A pretransplant assessment should establish the extent of disease and provide information about the individual's comorbidities that are likely to impact outcomes. This assessment varies by institution. It is expected that documentation of the pretransplant evaluation be included in the documentation maintained for the transplant’s billing and be available on request. The evaluation should include a significant portion of the following elements or documentation of the completion of the institution’s pre-established pre-transplant protocol, demonstrating the elements of that protocol. Detailed history Physical examination Laboratory studies A chest radiograph, an electrocardiogram, and a study of cardiac function Pulmonary function test Disease-specific restaging studies Functional status assessment Risk assessment for allogenic transplant (multiple scoring systems are available the European Group for Blood and Marrow Transplantation (EMBMT) is commonly used.1 Co-morbidity assessment (multiple scoring systems are available the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) is commonly used.1 Further studies may be required depending on signs and symptoms. PRETRANSPLANT COUNSELING (1) This A/B MAC suggests the following: Fertility preservation End-of-life and advance care planning Informed consent guidelines mandate that patients have an accurate understanding of the risks of HCT. Reference: Deeg HJ, Sandmaier BM. Determining eligibility for Allogeneic hematopoietic transplantation. In: Rosmarin AG, ed. UpToDate ; 2022 .