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Everything Matters When Billing for Blood Transfusions
MAY 2010
As published in the Medical News of Arkansas, Louisiana Medical News and Mississippi Medical News
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:
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-CPT codes for the procedures
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-Use the HCPCS Level II code (P9XXX) -The appropriate add-on codes to fully describe the product
(86945, 86960, 86965 or
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-CPT code 36430 for blood -36640 for push transfusion -36450 for exchange transfusions -36455 for exchange transfusions of other than newborn and -36460 for intrauterine (Fetal)
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-Units of service equals number of crossmatches
ordered and performed whether product was given or not, 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 |
-Unit of service is 1 per date of service. (CMS Pub 100-04, Ch. 4, ยง 231.8) - A commonly made billing error that is |
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-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. |
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-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 biologicalssuch 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):
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CPT/ HCPCS |
APC Payment Rate |
Units of Service |
Expected $$ |
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ABO |
86900 |
$ 7.83 |
1 |
$ 7.83 |
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Rh |
86901 |
$ 7.83 |
1 |
$ 7.83 |
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Antibody Screen |
86850 |
$14.80 |
1 |
$14.80 |
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Immediate Spin Crossmatch |
86920 |
$14.80 |
N/A @ this facility |
0 |
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Incubation Technique |
86921 |
$14.80 |
N/A @ this facility |
0 |
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AHG Technique (e.g., Gel) |
86922 |
$25.17 |
2 |
$50.34 |
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Leuko-reduced RBC |
P9016 |
$186.73 |
2 |
$373.46 |
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Blood Administration |
36430 |
$227.89 |
1 |
$227.89 |
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TOTAL |
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$682.15 |
