2025 CPT code 36516
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Therapeutic apheresis involving extracorporeal immunoadsorption, selective adsorption, or selective filtration with plasma reinfusion.
Modifier 26 (professional component) may be appended if the physician performs only the professional component, whereas the technical component is performed by another entity such as a clinical laboratory.
Medical necessity is established based on the presence of a specific condition requiring removal of pathogenic substances or blood components, such as in autoimmune disorders, hyperlipidemia, or certain types of blood cancers. The procedure must be deemed medically appropriate by the physician and should be supported by documentation indicating clinical necessity.
The physician or qualified healthcare professional performs the apheresis procedure, which involves accessing the patient's blood vessels, connecting them to the apheresis machine, monitoring the process, and ensuring safe reinfusion of the treated blood.They also manage any complications and provide pre- and post-procedure care.
In simple words: This medical procedure uses a machine to clean your blood.The machine removes unhealthy parts of your blood, like harmful substances or too many certain cells, and then puts the healthy parts back into your body. This helps treat various blood disorders.
Therapeutic apheresis is a procedure using specialized equipment to selectively remove blood components (plasma, leukocytes, platelets, or cells) from whole blood.The remaining blood is then reinfused. This code specifically covers therapeutic apheresis with extracorporeal treatment of the blood outside the body, involving immunoadsorption, selective adsorption, or selective filtration, followed by plasma reinfusion. The procedure involves removing harmful substances or excessive blood cells to treat disorders.
Example 1: A patient with autoimmune hemolytic anemia undergoes therapeutic apheresis to remove antibodies causing red blood cell destruction.The procedure involves extracorporeal immunoadsorption to bind and remove the harmful antibodies., A patient with thrombotic thrombocytopenic purpura (TTP) receives plasma exchange via apheresis to remove large von Willebrand factor multimers and restore platelet function. This involves selective adsorption or filtration., A patient with severe hyperlipidemia undergoes apheresis with selective filtration to remove excess cholesterol and lipoproteins from the plasma.
* Detailed patient history including symptoms, relevant medical conditions, and medications.* Complete blood count (CBC) with differential before, during, and after the procedure to monitor blood cell counts and detect any abnormalities.* Pre-procedure laboratory tests, such as coagulation studies, to assess the patient's bleeding risk.* Records documenting the apheresis machine settings, including flow rates, treatment duration, and volume of plasma removed or filtered.* Post-procedure evaluation of the patient's clinical status, including vital signs, physical exam findings, and lab results.* Documentation supporting medical necessity, such as clinical indications and rationale for selecting the specific apheresis technique and parameters.
** The selection of appropriate apheresis technique (immunoadsorption, selective adsorption, or selective filtration) depends on the specific clinical indication and the nature of the substances to be removed from the patient's blood.Careful attention should be given to ensuring proper documentation to support medical necessity and justify code selection.
- Revenue Code: P6C (Medicare Fee Schedule: MINOR PROCEDURES - OTHER)
- Payment Status: Active
- Modifier TC rule: The technical component is often billed separately from the professional component. The specific modifier choice depends on the billing entity and the nature of the services performed.
- Specialties:Hematology, Oncology, Nephrology, Immunology
- Place of Service:Hospital Inpatient, Hospital Outpatient, Ambulatory Surgical Center