... Polycythemia: primary and secondary. Polycythemia vera is a condition where a genetic mutation causes the bone marrow to make too many red blood cells (erythrocytosis or polycythemia), platelets (thrombocytosis), and white blood cells (leukocytosis).This increase in the blood cells, particularly the red blood cells, thickens the blood which slows blood flow. polycythemia vera, and secondary polycythemia. Therapeutic phlebotomy is a blood draw procedure usually prescribed by a physician as part of a treatment of various medical conditions associated with accumulation of excess iron in the body. It is the cheapest and most effective method for removing excess iron in nonanemic patients. Therapeutic Phlebotomy Abba Zubair, M.D., Ph.D. It's a lot like donating blood. Diagnosis (PLEASE CHECK ONE) Primary polycythemia (Polycythemia vera, other rare genetic polycythemias) Secondary polycythemia (due to testosterone therapy) Secondary polycythemia (not related to testosterone therapy) Polycythemia vera (PV) patients are treated with periodic therapeutic phlebotomy (TP) in order to maintain hematocrit levels <45% in an effort to reduce the incidence of thrombotic events [Marchioli NEJM 2013]. During this therapy, your doctor removes blood from your vein. Phlebotomy fees are charged for ALL OTHER DIAGNOSES. The excluded categories are polycythemia vera, secondary polycythemia, and porphyria cutanea tarda. Therapeutic Phlebotomy for Secondary Polycythemia Due to Obesity Hypoventilation Syndrome in a 12 Year Old Child. The word literally translates to “many blood”, and refers to an overproduction of red blood cells in the body. The reimbursement codes for therapeutic phlebotomy are CPT 39107, icd9 code 289.0. The treatment of hemochromatosis, polycythemia, and porphyrias. Phlebotomy Secondary Polycythemia due to D75.1 Testosterone Replacement Therapy D75.1Secondary Polycythemia, other D45Polycythemia Vera Hereditary Hemochromatosis E83.110 E83.118Other Hemochromatosis Other (Include both ICD-10 Code and Diagnosis): Minimum Hematocrit for Phlebotomy A phlebotomy is often the first treatment for polycythemia vera. Useful For. Before initiating the procedure, nurses must be aware of a patient s diagnosis, baseline hemoglobin, hematocrit, ferritin, and therapeutic end points. They may also be at increased risk for thrombosis, strokes, myocardial infarction, and deep venous thrombosis. These are the patients who require phlebotomy. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev.. Abstract 278 Journal of Hospital Medicine, Volume 9, Suppl 2. Unfortunately, therapeutic phlebotomy can be a difficult option to get reimbursed or covered by insurance companies. BloodworksNW’s is not able to bill for other categories of therapeutic phlebotomy and must discontinue service for these patients. People suffering from polycythemia have blood that is thick, viscous, or “sticky”, and the condition can be fatal. In: Kjeldsberg CR. Treatment includes phlebotomy with the possible addition of myelosuppressive agents based on a risk-stratified approach. Indications Therapeutic phlebotomy is indicated as an integral com-ponent of the treatment of several medical conditions. Some patients with extreme secondary polycythemia have impaired alertness, dizziness, headaches, and compromised exercise tolerance. Another source for therapeutic phlebotomy will need to be found by the prescribing physician for these indications. One such condition that responds to therapeutic phlebotomy is polycythemia. The blood center DOES NOT perform ferritin testing. Reviewing these diagnoses will help nurses understand why phlebotomy is an important part of treatment. 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