What do you charge to draw blood for L-PRF?

It is very difficult to charge a blood drawing fee , usually it is covered under medical insurance. I incorporate It into my iv fee. I like to use PRGF since it filters out the leukocytes therefore causing less inflammation, it gives great results and I no longer use PRP or other modalities. It took a course of trial and error to come up with this protocol. Perhaps building value in the extra fee thru scripted presentation would help get the patient to pay the extra fee. It works for us. Thanks for reading

D7921 - collection and application of autologous blood concentrate product. Charge is up to you. Typical collagen membrane will cost $60-120. Blood harvesting under $3 after purchase of centrifuge. Happy spinning.

Many clinicians are converting to L-PRF from PRGF. The statement that, if you remove leucocytes, you will get a better surgical result because of less inflammation is fallacy. First, let's look at the biology of tissue. The inflammatory cascade is a part of the normal wound sequence and is a necessary part of healing. You may use an anti-inflammatory after surgery (i.e. NSAID) to reduce pain and some soft tissue swelling, but if you use it for more than a day you actually retard healing. This is why cardiologists and orthopaedic surgeons won't let you use them post surgery. Leucocytes, on the other hand, are the main reservoir of vascular endothelial growth factor (VEGF) which is the cytokine responsible for angiogenesis. Remove them and you retard early blood vessel formation. But leucocytes also have an immunologic effect on grafted areas, demonstrably lowering incidence of post-operative infections. In every research paper that we have perused, L-PRF is clearly superior when compared to PRGF and PRP because growth factors are released over the longest period of time, particularly in the critical time period between soft tissue healing and early bone growth. This is singularly important in our discipline for early healing of dental implants. There are now over 100 peer-reviewed papers on PRF with all of them coming to the same conclusion with no controversy. RJM

To Robert Miller: the name of the Platelet rich fibrin is PRF. I know that Intra-lock want absolutely to involve itself in the L-PRF. But you must respect all the doctors who invent a new technique and provide to all the community a good technique for healing improvement. you need to respect the inventor(myself) and the name: PRF... Secundly, telling that leukocytes will decrease the infections rates is completely stupid !! you need to be updated..

the controversy about the leukocytes is so far ! all the new articles on vasculariszation insist on the essential role of the moncytes. the Advanced PRF (A-PRF) shows how to get BMP in the PRF through the monocytes activation..

Currently we are using the Advanced PRF from Dr. Choukroun, the originator and inventor of PRF, often copied, but I prefer to stick with the man who brought us this healing phenome! I often wonder know how I worked before this, everything seems to heal quicker, thicker and with less pain. Application in dental surgery is wide spread, can say enough about the improvement in patient outcomes and I know it's not an increase in my ability. Just look at the surgery only days later and they are healing and relatively pain-free. The patients leave and bleeding already is well controlled. At the cost and outcomes why would you not use Advanced PRF?

Going back to the original question of how you charge for the phlebotomy procedure. You do not charge to draw the blood, This seems more like trying to nickel and dime a higher fee. Consider what you would like to charge for the procedure and incorporate it in the fee for guided tissue regeneration. Good luck!

Two comments addressed the question. We don't charge to start our iv's or to draw blood for whatever product you choose to use. You need to include that in your fee, in my opinion. We don't charge for injection of local anesthesia either. Bvinci

Tawil, read my post. I said "in my opinion". I charge for the anesthetic, but I don't charge separately for starting the IV or drawing blood, wether it be for in house labs or a graft product. I use the code, but is does not apply that often. There is a code for delivery of local anesthetic. I choose not to charge for that per say, but it is included in my facility fees. Bvinci

Sport BV just confusing when someone writes "you need to include that in your fee" then adding "in my opinion". Since you are a well respected OMS it's sounds that you are laying the framework for this to be a free service when in fact the startup cost for this is not free nor cheap and its time consuming.

I agree, that we do have to start to charge for almost everything that we do, but in my opinion the actual drawing of the blood should be included in the fee( for the product ). Just as starting the IV is included in the general anesthetic. I don't charge for the access required to get to the iliac crest, when I do a graft. I am not trying to be sarcastic. Maybe I should charge for the blood draw. I don't charge for follow up visits, but I do charge for management of post op infections, or failure of an implant. Bvinci

Well I feel like an idiot, I asked my office manager if we charge for a blood draw and she informed me that often this D 7921 is used in the charges, sometimes it is necessary in billing our plan patients as a covered charge. It is for us a help with insurance issues and we unbundle our bone graft fee. I start an IV on most of these cases and draw from the catheter but if your using a butterfly and local I agree with the charge. It is interesting that the question is more a business model and insurance procedure, how our practices are set up clinically which can sometimes cause the difference of opinion. Thanks for educating me Tawildental I would not have known but my staff is on it! Also appreciate he discussion on blood products to learn more especially when reading articles and technique. I am not as intimately involved in developing and understanding these products just a consumer and "jawbreaker!"

Joseph; I have promoted many products over 30 years of practice, especially if I believe in them. If I talk about Intra-Lock's IntraSpin System, it is because it is the only PRF system at this time that has full FDA 510K clearance, something that Process for PRF or any of your new "versions" of PRF do not have. If we discuss the reduction of infections with PRF, it is because platelet derived growth factor (PDGF) is chemotactic for monocytes and other early healing cells. But this requires a rudimentary circulatory system to occur. And we all know that vascular endothelial growth factor (VEGF), also released by leucocytes, is directly responsible for early capillary sprouting. So I think that anyone would logically see that leucocytes, if not directly, are a part of a pathway that reduces infection. The transforming growth factor-β (TGF-β) superfamily is a group of structurally related growth factors that play prominent roles in a variety of cellular processes,including cell differentiation, wound healing, immune surveillance and bone morphogenesis. The TGF-β superfamily can be further divided into three major subfamilies: TGF-β, activin/inhibin/nodal, and bone morphogenetic protein (BMP) which includes BMP-2 and 7. All of these are present to some degree in PRF clots and are further enhanced by cell recruitment during early healing. But the suggestion that only A-PRF contains BMP-2 and 7 is, to use your own words, "completely stupid". I encourage a spirited debate on all new biologics. However, your personal attacks are sophomoric and have no place in this discussion. RJM

I thought the BMP 2 and 7 came from the activation of monocytes trapped in the A-PRF, demonstrated histologically, unlike L-PRF spinning at nearly double the RPM? Recent papers support the 200 RCF as less damaging to leukocytes as well. I would try the new parameters and see if you notice the higher tensile strength and quicker healing times, so far that has been my experience.

Joseph, I guess you just can't help yourself. So let me respond to each of your misguided statements. First, to date, I am not nor have I ever been a shareholder in ANY dental technologies company, Intra-Lock included. You know that from my previous postings on this website as well as personal emails to each other. For you to make a public accusation like that is not acceptable. Second, your statement about the Intra-Lock 510K being related to the centrifuge is flat out wrong. It is related to processing and using L-PRF. You need to do your homework with regard to FDA. Third, you have called the Intra-Lock instrumentation a "vulgar copy" of Process for PRF. This new instrumentation has been completely re-engineered and is now patent pending. You can't do that with a copy of existing technology. Fourth, you seem to be in love with monocytes (maybe it's a French thing). Monocytes are, in fact, a type of leucocyte along with basophils, eosinophils, neutrophils, and lymphocytes. Monocytes, neutrophils, and eosinophils are the main phagocytic cells. . Monocytes are agranular and bigger than the other leukocytes and these phagocytic cells defend the body against viruses and bacteria and account for 3-9% of all leukocytes. If you are trapping healthy, viable moncytes in PRF, then they have time to convert to macrophages (mature monocytes) to aid in early infection control. "The role of leukocytes from L-PRP/L-PRF in wound healing and immune defense: new perspectives." Bielecki T, Dohan Ehrenfest DM, Everts PA, Wiczkowski A. Curr Pharm Biotechnol. 2012 Jun;13(7):1153-62. In the abstract it states: "The presence of leukocytes has a great impact on the biology of these products, not only because of their immune and ANTIBACTERIAL PROPERTIES, but also because they are turntables of the wound healing process and the local factor regulation." This paper, and related articles, should be required reading for all those interested in autologous fibrin products. Last, you change the RPM's on your centrifuge and you want us to believe that you have created something new and unique, and that the trapped cells behave in a way that is completely different from other PRF preparations? Surely, serious students of the discipline would question your claims. Joseph, in this country we celebrate competition. So let's compete on the basis of knowledge and efficacy, not by personal attacks. RJM

time, temp,etc not just RPM, however... "me thinks the lady doth protest too much". L-PRF is dead, A-PRF is the new King! Besides I always prefered Elvis to his imitators. Advances in PRF should be common knowledge, shared with the profession to celebrate and debate. As dentists we already have enough people living out of our wallets.