Everything Matters When Billing for Blood Transfusions on Arkansas Medical News Inc.

Everything Matters When Billing for Blood Transfusions

By: BETTY HATTEN

There are three distinct categories of coding and billing that must coalesce for appropriate and compliant billing / reimbursement for blood transfusions as follows in the table below:

The Compatibility Testing	The Products	The Administration of the Product
CPT codes for the procedures ordered and performed according to methodology of the testing lab. Compatibility testing (Crossmatch) may be performed with any one or more of the following: 86920, 86921, 86922 or 86923	Use the HCPCS Level II code (P9XXX) that most accurately describes the product ordered and given The appropriate add-on codes to fully describe the product (86945, 86960, 86965 or 86985).	CPT code 36430 for blood transfusion 36640 for push transfusion(2 years or younger) 36450 for exchange transfusions of newborn 36455 for exchange transfusions of other than newborn and 36460 for intrauterine (Fetal) transfusion
Units of service equals number of crossmatches ordered and performed whether product was given or not, and 1 each of the following: ABO, Rh, antibody screen , and Each antibody identification procedures as required including: 86860, 86970- 86978.	Units of service matching the number of products actually given 1 unit of service of Autologous blood (86890) when the autologous unit or salvaged unit (86891) was not given. 1 unit of service for each unit of FFP that was thawed and not given using 86927.	Unit of service is 1 per date of service. (CMS Pub 100-04, Ch. 4, § 231.8) A commonly made billing error that is an “approved issue” for RACs. http://www.connollyhealthcare.com/RAC/pages/approved_issues.aspx
Revenue code 300 or 302	Revenue code is 390 if the product was acquired from a community blood bank that does not charge in excess of the processing and storage costs. Revenue code 38X if the product was purchased or the OPPS facility has its own blood donor center and charges more than the processing and storage costs.	Revenue Code is 391
The date of service is the date of collection and the testing was performed.	Date of service is the date the product was transfused.	Date of service is the date the product was transfused.

Do you have to use the BL modifier for blood products?

Probably not! Only OPPS hospitals using Revenue Codes 38X that purchase blood or run their own donor center, collect, process and store units of blood and blood components (“blood”) while charging more than the blood processing and storage are required to use the BL modifier and use revenue codes in the 038X. Note that if you do you use the 38X you must also use a line item for the 390 (processing and storage) and the BL modifier. (See the Medicare Claim Processing Manual Publication 100-04, Chpt. 4 Section 231.2 found at http://www.cms.hhs.gov/manuals/downloads/clm104c04.pdf.)

Prior to 1984, when the sale of body parts and tissue became illegal, donor centers often reimbursed blood donors cash (usually about $15) for a single unit of blood – in effect, purchasing living tissue. (Many of you may have your own memories of college days and being broke – and getting a quick $15 for a night out on the town! But I digress.) Today, the only blood products providers purchase are components, more often thought of as biologicals such as albumin and RhoGam. Both of these blood products are coded with the 636 revenue code, whether distributed through the pharmacy or the clinical lab’s blood bank.

If you capture all of the CPT/HCPCS codes, map to the proper revenue code, pay close attention to the appropriate units of service, a typical 2 unit outpatient blood transfusion should reimburse the following (based on Addendum B to the 2010 OPPS rules):

	CPT/ HCPCS	APC Payment Rate	Units of Service	Expected $$
ABO	86900	$ 7.83	1	$ 7.83
Rh	86901	$ 7.83	1	$ 7.83
Antibody Screen	86850	$14.80	1	$14.80
Immediate Spin Crossmatch	86920	$14.80	N/A @ this facility	0
Incubation Technique	86921	$14.80	N/A @ this facility	0
AHG Technique (e.g., Gel)	86922	$25.17	2	$50.34
Leuko-reduced RBC	P9016	$186.73	2	$373.46
Blood Administration	36430	$227.89	1	$227.89
TOTAL				$682.15

(To my readers, as I visit a different hospital almost every week, I am collecting humorous anecdotes from the coders, the transcriptionists, the ER and surgery staff, registration staff, labs, etc in preparation of an article titled “Two Spoons of Humor Makes the Hospital Go Around”. If you have a story, incident or a non-standard “abbreviation”, diagnosis, documentation of medical necessity criteria, please submit for an anonymous inclusion in an upcoming edition, please send to betty.hatten@horne-llp.com.). An example? Well there was the physician note stating the patient was CAL. “CAL” I asked? Crazy as a Loon, was the answer. There must be hundreds of these to share!)

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