To request a . Semin Hematol. On the other hand, menstruating women are seldom afflicted by gout, because the monthly blood loss causes them to accumulate iron to a much lesser degree. Total TPs during 2014, 2015, and 2016 were 475, 500, and 569, respectively. Length of treatment varied between 6 and 12 months. Iron reduction as an adjuvant to interferon therapy in patients with chronic hepatitis C who have previously not responded to interferon: A multicenter, prospective, randomized, controlled trial. 2022;46:101503. Risk stratification in primary myelofibrosis (PMF) should start with the International Prognostic Scoring System (IPSS) for newly diagnosed patients and dynamic IPSS for patients being seen during their disease course, with the addition of cytogenetics evaluation and transfusion status. 2012;18(29):3782-3786. Treatment of hypertension in older adults, particularly isolated systolic hypertension. Testosterone treatment of male hypogonadism. Following splenectomy, the patient developed a sustained increase in hematocrit, an increase in the frequency of painful episodes, as well as new-onset dizziness and malaise. A study about how to achieve the most effective blood-letting therapy may also need to be conducted in the future. Unfortunately, it can be difficult to qualify for reimbursement, or to get therapeutic phlebotomy covered by insurance. Zhu et al (2015) compared the differences in clinical effectiveness between pricking blood combined with moxibustion and Western medication (WM) for the treatment of AGA. Studies with JAK inhibitors are presently ongoing. These investigators reported a case series of 14 pediatric patients with HbSC treated to maximum tolerated dose (MTD) with hydroxyurea. The comprehensive outcomes, which combine the clinical symptoms, signs, and laboratory examinations as one outcome, were not internationally recognized and could not reflect the characteristics of interventions. the concentration of Hb level is known to influence the blood viscosity and its decrease always improved rheology in sickle cell disease patients; the mean corpuscularHb concentration is a critical factor concerning the HbS molecule polymerization in sickle cell disease, and its slight reduction may have an important biological effect. Blood Transfusion Service - Massachusetts General Hospital UpToDate [online serial]. Pediatr Transplant. 2003;42(12):1550-1555. PROs have been recommended to be reported for RCTs. Two RCTs specifically included only patients with either high ferritin or high hepatic iron content. Therapeutic phlebotomy for testosterone-induced polycythemia. This is the American ICD-10-CM version of E83.119 - other international versions of ICD-10 E83.119 may differ. margin-top: 38px; The conditions/diagnoses under which a therapeutic phlebotomy can be paid are as follows: Polycythemia vera (238.4) Polycythemia secondary (289.0) to: background: #5e9732; Waltham, MA: UpToDate; reviewed May 2015. We will continue to require a therapeutic phlebotomy request form to be completed by your doctor and kept on file with Gulf Coast Regional Blood Center. In an ER setting, an "encounter" is considered admission until discharge. Du YZ, Jia CS, Shi J, et al. 2005:58-65. These investigators stated that therapeutic phlebotomy was feasible and effective, and would prevent complications of iron overload. hr.separator { Bacon BR, Kwiatkowski JL. Can Fam Physician. Percent dense red blood cells (%DRBC) were measured via an ADVIA hematology analyzer. Quantitative phlebotomy was employed to remove iron in 12 hyperuricemic patients with GA and maintained their body iron at near-iron deficiency (NID) level (i.e., the lowest body iron store compatible with normal erythropoiesis and therefore absence of anemia). Synder PJ. Iron overload in mild sideroblastic anaemias. (Accessed December 8, 2022) Covered Clinical Diagnostic Laboratory Tests and Services Clinical diagnostic laboratory tests and services are covered when criteria are met. If the phlebotomy was planned prior to the visit and nothing seperately identifiable was done you would eat the visit and only bill the phlebotomy. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; An UpToDate review on Approach to the patient with suspected iron overload (Bacon and Kwiatkowski) does not mention phlebotomy as a therapeutic / management option for hyperferritinemia in alcohol liver disease. 2006;81(10):760-767. JG Murphy, ed. Med Hypotheses. These researchers presented a pediatric case of a successful liver transplantation from a donor with beta-thalassemia intermedia. Too much of it can affect the nervous system, cause gastrointestinal pain, or affect the skin. Omaha, NE: eMedicine.com; updated December 18, 2001. Sfeir HE, Klachko DM. 63:1049-1066. Philadelphia-negative classical myeloproliferative neoplasms: Critical concepts and management recommendations from European LeukemiaNet. Copyright Aetna Inc. All rights reserved. Medicare coverage for many tests, items and services depends on where you live. Bloodletting therapy for patients with chronic urticaria: A systematic review and meta-analysis. Scheduled phlebotomy goodies people who have too much iron in their bluts, such as from hemochromatosis, or anyone is creating too many red blood cells, such as with polycythemia.Removing blood regularly decreases iron plane included which body by reducing the number of iron-rich red blood cells. eMedicine Dermatology Topic 344. Management of hemochromatosis. # color: white; The moxibustion was adopted for 10 days. Greenway A, Ware RE, Thornburg CD. Pilot studies suggested that HCV-infected patients with elevated concentrations of iron in the blood and liver are less likely to respond to interferon, and that the response could be enhanced with iron reduction. The authors concluded that during a 28-month follow-up, maintenance of NID was found to be safe and beneficial in all patients, with effects ranging from a complete remission (CR) to a marked reduction of incidence and severity of gouty attacks. The follow-up trial (STOP 2) indicated that individuals may revert to former risk status if transfusion is discontinued. (Grade 1B). Labcorp Testing Services (blood work, COVID tests, routine labs) | Labcorp right: 30px; After the right amount of blood is drawn, the nurse will remove the needle and place a pressure bandage (bandage that wraps around your arm) over the needle site (the place on your arm where the . Berlin NI. The first 2 trials addressed the use of chronic transfusion to prevent primary stroke; the third utilized the drug hydroxycarbamide (hydroxyurea) and phlebotomy to prevent both recurrent (secondary) stroke and iron over-load in patients who had already experienced an initial stroke. All About the Therapeutic Phlebotomy - Verywell Health Dienstag JL, McHutchison JG. The presently available treatment options in PV were discussed and recommendations for the clinical management were given. A proposed rule issued by the Centers for Medicare and Medicaid Services, calls for relatively small decreases in payments for certain widely transfused blood products (e.g., the payment for leukoreduced RBCs would fall from $198.90 in 2012 to $193.19 in 2013). Date of the latest search of the Group's Haemoglobinopathies Trials Register was January 28, 2013. Rotker KL, Alavian M, Nelson B, et al. This can lead to fainting. Valenti and colleagues (2012) stated that non-alcoholic fatty liver disease (NAFLD), defined by excessive liver fat deposition related to the metabolic syndrome, is a leading cause of progressive liver disease, for which accurate non-invasive staging systems and effective treatments are still lacking. Perloff JK, Marelli AJ, Miner PD. Iron overload and prolonged ingestion of iron supplements: Clinical features and mutation analysis of hemochromatosis-associated genes in four cases. However, all completed clinical trials of hydroxyurea have excluded patients with hemoglobin SC (HbSC) disease; HbSC differs significantly in pathophysiology from HbSS, as HbC does not sickle, but instead causes cellular dehydration which potentiates sickling of HbS. Adult congenital heart disease. Valenti L, Dongiovanni P, Fargion S. Diagnostic and therapeutic implications of the association between ferritin level and severity of nonalcoholic fatty liver disease. If your test, item or service isn't listed, talk to your doctor or other health care provider. Am J Clin Pathol. Burden of Phlebotomy in Patients with Polycythemia Vera in the United text-decoration: underline; The authors concluded that parents of 13/14 children receiving phlebotomy wished to switch to deferasirox, with 1/14 being satisfied with phlebotomy. Lengfelder E. Diagnosis and therapy of polycythemia vera in the era of JAK2. Adjarov D, Donov M, Ivanov E, Naidenova E. Phlebotomy treatment in porphyria cutanea tarda combined with beta-thalassaemia. Subsequently, the identification of several other mutated genes in MPN has shown that the pathogenesis is complex and that the JAK2V617F mutation is a critical, but not the only step leading to the uncontrolled proliferation in MPN including PV. Kim KH, Oh KY. Clinical applications of therapeutic phlebotomy. color:#eee; Providing a Simple and Effective Treatment Schrier SL, Bacon BR. color: white; 2004;44(6):833-837. J Infus Nurs. Instructions After Your Therapeutic Phlebotomy Procedure Is your test, item, or service covered? | Medicare Early attempts to lower iron burden including chelation therapy and/or phlebotomy should be considered to avoid organ toxicity and transplant failure. The authors stated that adequately powered RCTs with detailed pre-treatment iron studies should be considered to evaluate phlebotomy as an adjunct to pegylated IFN, with or without ribavirin. Approach to the patient with suspected iron overload. Kowdley KV, Brown KE, Ahn J, Sundaram V. ACG Clinical guideline: Hereditary hemochromatosis. These are referred to as therapeutic phlebotomies. The risk of allogeneic stem-cell transplantation-related complications is justified in transplantation-eligible patients whose median survival time is expected to be less than 5 years. A total of 11 clinical trial papers involving 826 cases of migraine were included in the present paper; 3 of them were high-quality researches, and the other 8 were low quality researches. The Cochrane Risk Assessment Tool was used to assess the methodological quality of trials. After discontinuation of TP services for TRT at their BC, 32 % continued to donate as volunteer blood donors at their BC. If therapeutic fluid administration is medically necessary (e.g., correction of dehydration, prevention of nephrotoxicity) before or after transfusion or chemotherapy, it may be reported separately. During NID, attacks were also more often of milder severity. Besides, the Global Allergy and Asthma European Network (GA2LEN) recommended patient-reported outcomes (PROs) and health-related quality of life (HR-QOL) in patients with urticarial. Peto odds ratios with their 95 % confidence intervals (CI) and Forrest plots were generated for each variable to assess the relationships among the studies that had provided that information. Transfusion. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; Under CPT/HCPCS Modifiers added modifier 59. These investigators also stated that maintenance of NID by depleting the levels via phlebotomy in patients with gout induces either complete or marked reduction in incidence and severity of gout flares in humans. The included articles were examined for bias risk by using the Cochrane risk of bias assessment tool. American Gastroenterological Association medical position statement on the management of hepatitis C. Gastroenterology. @media print { } The authorsinitiated a therapeutic phlebotomy program in order to lower the hematocrit to pre-splenectomy values, as well as to induce iron deficiency. No blood-letting was further required during a 6-month period after introduction of rhEPO. Chin-Yee B, Lazo-Langner A, Butler-Foster T, et al. Moreover, they stated that ongoing multi-center trials are investigating the use of chronic transfusion to prevent silent infarcts, the use of hydroxyurea as an alternative to transfusion in children with abnormal transcranial Doppler ultrasonography velocities, and the use of hydroxyurea to prevent conversion of transcranial Doppler ultrasonography velocities from conditional (borderline) to abnormal values. The reported adverse effects were well-tolerated. Inati et al (2017) stated that iron overload is well documented in patients with beta-thalassemia major, and patients who have undergone hematopoietic stem cell transplantation (HSCT) remain at risk as a result of pre- and immediate post-HSCT transfusions. These researchers stated that further rigorously designed trials are needed to confirm these findings. A total of 6prospective RCTs were identified: all used sustained viral response (SVR) as an endpoint. maintenance of the serum ferritin level at 50 ug/L or less thereafter by periodic removal of blood. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. The authors stated that phlebotomy appeared to enhance the efficacy of non-pegylated IFN monotherapy for CHC, but more research was required to confirm this. Guidelines from the American Gastroenterological Association (Dienstagand McHutchison, 2006) on management of hepatitis C concluded that clinical trials have failed to demonstrate the efficacy of phlebotomy in patients with chronic HCV infection, and that phlebotomy cannot currently be recommended as a treatment for HCV infection. J Clin Oncol. Haematologica. The Endocrine Society guidelines suggest stopping therapy if the hematocrit increases to 54 %. Vitamin C supplements and iron supplements should be avoided. A JAK2 mutation is found in approximately 60 % of patients with ET. Transfusion. Waltham, MA: UpToDate; reviewed May 2020. Typically, therapeutic phlebotomy consists of (i) removal of unit (450 to 500 ml) of blood weekly until the serum ferritin level is 10 to 20 ug/L, and (ii) maintenance of the serum ferritin level at 50 ug/L or less thereafter by periodic removal of blood. outline: none; Markham MJ, Lottenberg R, Zumberg M. Role of phlebotomy in the management of hemoglobin SC disease: Case report and review of the literature. However, randomized controlled clinical trials of therapeutic phlebotomy for HCV treatment have not found significant improvements in sustained virologic response with phlebotomy plus interferon (IFN) compared to IFN alone (Fonatana et al, 2000; Di Bisceglie et al, 2000). High-risk patients with ET should be managed with cytoreduction, using hydroxyurea at any age. 2006;32(1):10-16. list-style-type: upper-roman; Therefore, iron can increase the activity of xanthine oxidase, the sole enzymatic source of urate in human beings. If the hematocrit normalizes, a lower dose of testosterone should be continued or restarted. Cell Mol Biol (Noisy-le-grand). border-width:0; 2005;10(2):145-149. A patient, 6-year old girl, with a diagnosis of cryptogenic liver cirrhosis underwent deceased donor liver transplantation from a thalassemic donor. Therapeutic Phlebotomy | Defy Medical Those who failed to show clinical improvement after at least 6 months at MTD were offered phlebotomy in addition to hydroxyurea; 5 out of 11 patients with HbSC who achieved MTD failed to demonstrate clinical improvement on hydroxyurea. Clinical observation of pricking blood combined with moxibustion for acute gouty arthritis. These investigators will include RCTs assessing BL for the common cold. These researchers noted that Kowdley et al recently demonstrated in a multi-center study in 628 adult patients with NAFLD from the NAFLD-clinical research network database with central re-evaluation of liver histology and iron staining that the increased serum ferritin level was an independent predictor of liver damage in patients with NAFLD, and was useful to identify NAFLD patients at risk of non-alcoholic steatohepatitis and advanced fibrosis. This trial was stopped early after enrolment and follow-up of 133 children because of analysis showing futility in reaching the composite primary end-point. Third, the combination of different area selection and duration types of blood-letting therapy may have caused significant clinical heterogeneity. The 10-year risk of leukemic/fibrotic transformation is less than 1 %/1 % in ET and less than 3 %/10 % in PV. Available at: http://www.emedicine.com/DERM/topic344.htm. The transfusion group had a high complications rate, including iron over-load, allo-immunization, and transfusion reactions. If the hematocrit cannot be kept below the upper limit of normal, even when the serum testosterone concentration is at the low end of the normal range during testosterone treatment, the patient should be evaluated for hypoxia and sleep apnea. Of the 27 repeat donors, 12 (44 %) had persistently elevated Hb levels (greater than or equal to 180 g/L) at subsequent donations. The efficacy of bloodletting therapy in patients with acute gouty arthritis: A systematic review and meta-analysis. London, UK: British Society for Haematology; 2005. Accessed November 12, 2002. Estimated absorption of iron from supplements in patients 1 to 4 was 20.9 %, 1.9 %, 1.1 %, and 0.08 %. 2017;57(3):578-581. The authors concluded that the STOP trial demonstrated a significantly reduced risk of stroke in participants with abnormal transcranial Doppler ultrasonography velocities receiving regular blood transfusions. Language services can be provided by calling the number on your member ID card. Cor pulmonale. High-risk patients with PV should be managed with phlebotomy, low-dose aspirin, and cytoreduction, with either hydroxyurea or interferon at any age. Creange A, Lefaucheur JP, Balleyguier MO, Galacteros F. Iron depletion induced by bloodletting and followed by rhEPO administration as a therapeutic strategy in progressive multiple sclerosis: A pilot, open-label study with neurophysiological measurements. evoked migraine, pricking blood used as a complementary therapy, case report, specialists' experience summary, reviews, surveys, news articles, animal studies were excluded. A total of 7 sickle cell disease patients (4 sickle cell anemia,3 sickle Hb C disease), aged4 to 24 years, were submitted to sequential phlebotomies during periods from 18 months to4 years. If no treatable cause is found, phlebotomy can be considered. is therapeutic phlebotomy covered by insurance Haematologica. Survival is near-normal in ET and reasonably long in PV. Gumus et al (2017) stated that the use of extended criteria donors who might have previously been deemed unsuitable is an option to increase the organ supply for transplantation. An UpToDate review on Prognosis and treatment of polycythemia vera (Tefferi, 2013) states that In subjects without active thrombosis and those not at risk for thrombosis (i.e., age of less than 60, no prior thrombosis), we recommend that the hematocrit be kept within the normal range via the use of serial phlebotomy, rather than by the use of myelosuppressive agents (Grade 1A). Cook LS. Seventy-six percent of respondents reported full or partial insurance coverage of therapeutic phlebotomy charges. Is therapeutic phlebotomy covered by insurance? This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. This threshold has been interpreted by some physicians and patients to indicate the need for phlebotomy or blood donation while on TRT. .arrowPurpleSmall, a:hover.arrowPurpleSmall { 2003;49:36-43. Zhao Q-W, Liu J, Qu X-D, et al. The phlebotomy plus IFN group and the IFN group did not differ with respect to the percentage of patients with cirrhosis or genotype 1. } Therapeutic phlebotomy is used to remove excess iron and maintain low normal body iron stores in patients with hemochromatosis. Ann Intern Med. In a Cochrane review, Wang and Dwan (2013) evaluated risks and benefits of chronic blood transfusion regimens in people with sickle cell disease to prevent first stroke or recurrences. A total of 60 cases were randomly divided into an observation group and a control group, 30 cases in each group. padding-right: 18px; These researchers carried out HFE mutation analysis to detect C282Y, H63D, and S65C in each patient; in 2 patients, HFE exons were sequenced. Compared with anti-hypertensive drugs, blood pressure (BP) was significantly reduced by BLT (RR = 1.21, 95 % CI: 1.01 to 1.44, p = 0.03; heterogeneity: p = 0.06, I2 = 60 %) and BPAD (RR = 1.25, 95 % CI: 1.02 to 1.53, p = 0.03; heterogeneity: p = 0.01, I2 = 71 %). For this purpose we prefer the use of hydroxyurea rather than an alkylating agent, radioactive 32P, or interferon alpha. Interferon treatment regimes varied. 2015;35(9):885-888. Treatment with higher doses should be avoided. list-style-type: lower-alpha; The authors concluded that these findings indicated that incorporation of serum ferritin level may improve the performance of non-invasive scoring of liver damage in patients with NAFLD, and that iron depletion (most frequently achieved by phlebotomy) still represents an attractive therapeutic target to prevent the progression of liver damage in these patients. Pflieger K.Pulmonary hypertension, Eisenmenger syndrome. A survey of phlebotomy among persons with hemochromatosis This observation promptedthese researchersto identify the potential utility of iron load reduction in the management of this disease. Tefferi A. Polycythemia vera and essential thrombocythemia: 2012 update on diagnosis, risk stratification, and management. Clinical complications, which include liver cirrhosis, heart failure, hypogonadotropic hypogonadism and diabetes, appear earlier and are more severe than in HFE-related hemochromatosis. 2019;114(8):1202-1218. Billing therapeutic phlebotomy and E/M - AAPC # font-weight: bold; A marked rise in percent dense cells preceded clinical complications in 3 patients. After treatment, blood UA decreased significantly in the 2 groups (both p < 0.01), the observed group being lower than the control group (p < 0.01). Crit Rev Clin Lab Sci. 2017;64(1):188-196. PDF CHAP11-CPTcodes90000-99999 Revision Date: 5/1/2022 CHAPTER XI - CMS 1993;87(6):1954-1959. Available at: http://www.emedicine.com/med/topic975.htm. Medicare Advantage (Part C) plans may cover more tests, depending on the plan. Services Not Covered by Medicare | AAFP Dtsch Med Wochenschr. A meta-analysis on pricking blood therapy for migraine. In a review on evidence-based approach for the treatment of adults with sickle cell disease, Lottenberg and Hassell (2005) noted that reports and case series indicated that repeated phlebotomy to lower the hemoglobin (Hb) level and induce iron deficiency can reduce the frequency of painful episodes in selected patients with high steady state Hb levels. Yao Q, Zhang X, Mu Y, et al. Br J Dermatol. The authors concluded that large scale clinical trials are needed to evaluate the safety and effectiveness of hydroxyurea and hydroxyurea with phlebotomy in patients with HbSC disease. The JAK2V617F mutation, a point mutation in the tyrosine kinase gene JAK2 (Janus Kinase 2), has emerged as a central feature in the pathogenesis of MPN. The Helicobacter pylori (or H. Pylori) breath test is a simple and safe test used to detect an active H. pylori infection. Therapeutic phlebotomy may be indicated for hemochromatosis, polycythemia vera, porphyria cutanea tarda, and polycythemia secondary toarterio-venous fistulae, cyanotic congenital heart disease or cor pulmonale. Tefferi A. Prognosis and treatment of polycythemia vera. Adults with cyanotic congenital heart disease: Hematologic management. Treatment with busulfan or interferon- is usually effective in hydroxyurea failures. is therapeutic phlebotomy covered by insurance. A patients guide to phlebotomy.