Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin 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 and Non-Hodgkin Lymphoma with B-cell or T-cell Origin DL39513 . 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. A pretransplant assessment, even accounting for institutional variations, should establish the extent of disease and provide information about the individual's comorbidities that are likely to impact outcomes. The pretransplant 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. History and physical examination which includes: Detailed history Physical examination All relevant laboratory studies A chest radiograph, an electrocardiogram, and a study of cardiac function Pulmonary function test Disease-specific restaging studies Further studies may be required depending on signs and symptoms. It is expected that documentation of the pretransplant evaluation be included in the medical record that supports the transplant’s billing and be available on request. PRETRANSPLANT COUNSELING This A/B MAC suggests the following: Fertility preservation discussion, if relevant End-of-life and/or advance care planning Allogeneic Hematopoietic Cell Transplantation represents intense therapy for severe disease. Therefore, Palmetto GBA expects documentation relating the precise benefits and risks to a beneficiary in such a way that it is clear the discussion was tailored to the individual patient. Informed consent guidelines should show that patients have an accurate understanding of the risks of HCT. (Deeg & Sandmaier, Determining eligibility for allogeneic hematopoietic transplantation. UpToDate. 2022).