Regarded as a serious immune disorder, immune thrombocytopenia (ITP) occurs when the blood in the body doesn’t clot quickly as the body has low levels of platelets – the cells that help blood clot. Formerly known as idiopathic thrombocytopenic purpura, the condition can lead to easy or excessive bruising and bleeding (both internally, as well as on and under the skin). The condition can cause purple bruises as well as tiny reddish-purple dots that look like a rash. If left untreated, it can lead to severe complications like bleeding into the brain, which can be fatal. Treatment modalities for the condition include medications (to boost platelet count) or surgery to remove spleen. Physicians administering treatment modalities for this condition must document the diagnosis and other related medical procedures with the correct medical codes. Accurate documentation, provided by efficient medical billing outsourcing companies, can help providers communicate diagnosis, treatment, and results on the claims for proper reimbursement.
Reports suggest that immune thrombocytopenia (ITP) affects approximately 50 to 150 people per million, and it can occur in anyone at any age, though it is more prevalent in adults after the age of 60. In fact, about 40 percent of all cases affect children, though it seems to develop most frequently in kids in the age group of 2-4 years. Children may develop ITP after a viral infection and usually recover fully without treatment. In adults, the disorder is often long term.
Causes and Types of ITP
Typically, ITP occurs when the immune system mistakenly attacks and destroys platelets. The condition is more common in young women and the risk appears to be higher in people who have rheumatoid arthritis, lupus and antiphospholipid syndrome. The immune disorder is not contagious and cannot be passed from one person to another. In adults, the condition may be triggered by chronic infections like HIV, hepatitis or H. pylori. In most children with ITP, the disorder follows a viral illness, such as the mumps or the flu. Other possible triggers include – other autoimmune diseases, usage of certain medications (like ibuprofen or asprin), dehydration, trauma, pregnancy and certain types of cancer. There are two different types of immune thrombocytopenia (ITP) namely – acute ITP and chronic ITP. One of the common forms of disorders among children, acute ITP is short-term, lasting less than 6 months. Chronic ITP, on the other hand can affect anyone and is long-term, lasting for 6 months or longer.
Symptoms of ITP
ITP doesn’t always cause any specific, noticeable symptoms. In certain cases, the condition can be asymptomatic for long periods of time and not have any symptoms until they have an episode. Other common symptoms include –
- Easy or excessive bruising
- Superficial bleeding into the skin (pinpoint-sized reddish-purple spots (petechiae) that look like a rash, usually on the lower legs)
- Abnormally heavy menstruation
- Blood in the urine or stool
- Cuts that take a long time to stop bleeding or scab over
- Profuse bleeding during surgery
- Spontaneous bleeding from the gums or nose
How Is ITP Diagnosed and Treated?
Diagnosis of ITP begins with a physical examination and medical history evaluation. Physicians will perform blood tests that measure – a complete blood count (CBC), electrolyte levels, liver and kidney function and platelet antibodies. In certain cases, physicians may perform a blood smear test (that verifies the number and appearance of platelets seen in the complete blood count). In rare cases, adults may need a bone marrow exam to rule out other problems. People with mild ITP may require nothing more than regular monitoring and platelet checks. Usually, children with this condition do not require any specific treatment. On the other hand, adults with ITP will eventually need treatment, as the condition often becomes severe or long term (chronic). Treatment includes a combination of medications (to boost platelet count) and splenectomy (surgery to remove spleen). In severe or widespread cases of ITP, emergency treatment may be involved. This usually includes transfusions of concentrated platelets and intravenous administration of medications (like corticosteroid like methylprednisolone (Medrol), IVIg, or anti-D treatments).
Medical Codes for ITP
The diagnoses and treatment procedures administered must be carefully documented using the correct medical codes. Medical billing services provided by reputable providers can ensure the correct codes on the medical claims. Medical codes for ITP include –
ICD-10 Codes
- D69.3 Immune thrombocytopenic purpura
CPT codes
- 38100 Splenectomy; total (separate procedure)
- 38120 Laparoscopy, surgical, splenectomy
- 90283 Immune globulin (igiv), human, for intravenous use
- 96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
HCPCS Codes
- J1459 Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg
- J1460 Injection, gamma globulin, intramuscular, 1 cc
- J1556 Injection, immune globulin (bivigam), 500 mg
- J1557 Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg
- J1560 Injection, gamma globulin, intramuscular, over 10 cc
- J1561 Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg
- J1566 Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg
- J1568 Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg
- J1569 Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg
- J1572 Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg
- J1599 Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg
- J2788 Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.)
- J2790 Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)
- J2791 Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu
- J2792 Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu
- J2796 Injection, romiplostim, 10 micrograms
- J8499 Prescription drug, oral, non-chemotherapeutic, nos
- J9312 Injection, rituximab, 10 mg
For most people with mild ITP, the condition isn’t life-threatening and resolves without treatment. On the other hand, chronic ITP can last for many years. People with ITP can effectively manage their condition without any long-term complications. Incorporating certain lifestyle changes such as avoiding certain over-the-counter drugs (that can affect platelet function), limiting the intake of alcohol (as this can adversely affect blood clotting) and choosing low-impact activities instead of competitive sports or other high-impact activities may be beneficial.
Accurate clinical documentation of the causes, types, symptoms and treatment procedures is crucial to ensure accuracy in coding and billing. Availing the services of experienced medical billing companies can help physicians assign the right medical codes for this condition, and ensure optimal reimbursement.
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