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AABB > Programs & Services > Billing and Reimbursement Initiatives

Billing for Blood and Transfusion Services: Frequently Asked Questions and Answers 

As a service to our members, AABB has consulted several experts to provide responses to your questions regarding the coding and billing of blood products and transfusion services reimbursable under the Medicare program. The responses below reflect the opinions of those experts based on the Internet Only Manuals available at http://www.cms.hhs.gov/Manuals/IOM/list.asp and the 2007 edition of the American Medical Association Current Procedural Terminology (CPT) (CPT is a registered trademark of the American Medical Association). The responses are limited to the facts presented in the questions. AABB assumes no legal liability for the use of these responses in seeking reimbursement for services reimbursable under the Medicare program. You are advised to consult persons responsible for the coding and billing of services at your institution, as well as the Medicare contractor for your geographical location, to ensure the correct coding and billing of services provided at your institution.

Providers are advised that CPT and HCPCS codes and CPT/HCPCS modifiers are to be used only in an outpatient setting. CPT and HCPCS codes, as well as CPT/HCPCS modifiers are not used in an inpatient setting.

AABB wishes to thank AdvaMed for its valuable assistance in producing these Frequently Asked Questions and Answers. In particular, AABB appreciates the generous support of the following member companies of AdvaMed: Cerner, Fenwal, Gambro BCT, Gen-Probe, Novartis Vaccines and Diagnostics, Olympus America, Diagnostic Systems, Ortho-Clinical Diagnostics, Roche Diagnostics, and Terumo Medical.

Billing the Processing Charge Only
Blood Deductible
Billing for Autologous Blood
Billing Split Units
Billing Irradiated Units
Billing for Frozen & Thawed Products
Billing for Jumbo Plasma
Billing for Transfusion Reactions
Billing for Pheresis and Apheresis Service
Billing for Transfusion Services
Billing for Antigen Testing

Billing the Processing Charge Only

Question: We are a nonprofit hospital obtaining our blood products through another nonprofit blood bank which collects blood through volunteer donors. Our model has required us to report Revenue Code 0390 on our claims since time immemorial. Please confirm that organizations such as ours do not need to report BL modifiers. We do not purchase blood; we pay for processing costs.

Also, we are told by our fiscal intermediary (FI) that Revenue Code 0390 requires a HCPCS code, which I have never known to be the case. Is this true?

Answer: In the hospital outpatient setting, the "P" code -BL modifier is to be used for Revenue Codes 038X plus 039X when the hospital receives allogeneic blood components from suppliers that charge for the liquid blood or collects their own blood and charges for the liquid blood as well as for processing fees (the outmoded "replacement fees" charged by some facilities would fall in this category). Based on your statement that only processing fees are charged for allogeneic blood, you do not have to use -BL modifier and the two revenue codes (038X and 039X).

Revenue Code 0390 (or 0391 for Blue Cross/Blue Shield) is the appropriate revenue code when charging for transfused allogeneic/autologous blood components. Your FI is correct, a blood component HCPCS code ("P" code) should be attached to this revenue code when billing for transfused blood components as well as CPT 36430 once per day per transfused patient in the hospital outpatient setting. Transfusion Medicine services, such as type & screen, crossmatch, etc. (CPT 86850-86999), are billed using the laboratory Revenue Code 030X, whether the units are transfused or not transfused.

Reference

Medicare Claims Processing Manual Chapter 4, Section 231.2 and 231.7

Blood Deductible

Question: We are trying to ensure that we are billing blood deductibles correctly. We have received conflicting information on whether P9016 Red blood cells, leukocytes reduced, each unit, qualifies for the blood deductible, and the correct revenue code it belongs in. Could you clarify it for us, please?

Answer: If the facility is not billing for blood and billing only the processing, the blood deductible rule does not apply. The question infers, however, that the facility is billing for the blood product in addition to the processing. Therefore, the blood deductible would apply. Medicare defines items subject to the blood deductibles as whole blood and packed red cells. Medicare makes the distinction to clearly exclude other components such as platelet, plasma, etc. from the blood deductible requirement. Medicare does not limit the type of red blood cells by further refining the definition. Therefore, all red blood cells, leukoreduced, irradiated, etc., are included in the calculation of the blood deductible.

The provider must report the charges for the blood using Revenue Code series 038X, the appropriate blood product code, the number of units transfused and the HCPCS modifier BL. The collection processing and storage services are reported using Revenue Code 0390 or 0391 with the appropriate blood product code, the number of units transfused and the HCPCS modifier BL. Whenever there is a charge for the blood, there must be a corresponding charge for processing. Both charges must use the BL modifier and have the same line item date of service.

The Medicare instructions for billing and the associated value codes for both the electronic claim, 837, and the paper claim UB-92/UB-04 are:

06     Medicare Part A and Part B Blood Deductible
The product of the number of un-replaced deductible pints of blood supplied times the charge per pint. If the charge per pint varies, the amount shown is the sum of the charges for each un-replaced pint furnished. If all deductible pints have been replaced, this code is not to be used.

When the hospital gives a discount for unreplaced deductible blood, it shows charges after the discount is applied.

37     Pints of Blood Furnished
The total number of pints of whole blood or units of packed red cells furnished, whether or not they were replaced. Blood is reported only in terms of complete pints rounded upwards, e.g., 1 1/4 pints is shown as 2 pints. This entry serves as a basis for counting pints towards the blood deductible.

38     Blood Deductible Pints
The number of un-replaced deductible pints of blood supplied. If all deductible pints furnished have been replaced, no entry is made.

39     Pints of Blood Replaced
The total number of pints of blood that were donated on the patient’s behalf. Where one pint is donated, one pint is considered replaced. If arrangements have been made for replacement, pints are shown as replaced. Where the hospital charges only for the blood processing and administration, (i.e., it does not charge a “replacement deposit fee” for un-replaced pints), the blood is considered replaced for purposes of this item. In such cases, all blood charges are shown under the 039X revenue code series (blood administration) or under the 030X revenue code series (laboratory).

References

  1. Medicare General Information, Eligibility and Entitlement Manual, Chapter 3; section 20.5.3 Items Subject to Blood Deductible
  2. Medicare Claims Processing Manual, Chapter 4, Section 231.2
  3. Medicare Transmittals 1104, November 3, 2006, and 1058, September 15, 2006

Billing for Autologous Blood

Question: For outpatient autologous transfusions should we bill CPT 86890 at the time of collection for the collection fee?

Answer: Billing CPT code 86890 or 86891 is permitted only in the hospital outpatient setting when the autologous blood is collected but not transfused. For transfused autologous blood, Medicare states that hospitals must be certain that the blood is not transfused and instructs providers to bill on the transfusion date or date of outpatient discharge, not on the date the autologous blood was collected. The facility would bill the transfusion code 36430 and the appropriate blood product HCPCS code. The facility would not bill 86890 or 86891 as the payment amount for the blood product code includes the collection, processing, transportation, and storage.

If the patient does not receive the autologous unit, the facility may bill CPT code 86890 for the collection of the autologous unit on the date of the scheduled procedure or outpatient discharge. This code may be reported only in the hospital outpatient setting. The appropriate Revenue Code would be 0300 (laboratory) or 0302 (Immunology).

Reference

Medicare Claims Processing Manual, Chapter 4; Section 231.3

Question: How do we bill for autologous units for patient when the blood is collected as an outpatient but later transfused as an inpatient. Should we bill HCPCS P9021 for the transfusion service charges (retype, special inventory, storage) in addition to the original collection fees or should we build the transfusion service charges into CPT 86890 and not bill P9021 at all?

Answer: Even if the autologous unit was collected within 72 hours of admission and transfused as an inpatient service, all charges (patient testing and product collection and processing) are included under the DRG payment. Use of CPT and HCPCS codes are not required for inpatient billing. In the unusual event that the autologous unit was collected and transfused in an “outpatient” setting, the facility would bill the appropriate revenue center code for the transfusion service with code 36430, and the appropriate Revenue Code (0390 - 0399) for the blood product code, P9021. The facility would not bill 86890 for the autologous collection and processing as the payment for these services is included in the pricing for P9021. If the autologous unit is collected within 72 hours of admission, all services are included under the DRG.

Reference

Medicare Claims Processing Manual, Chapter 4; Section 231.3

Question: If autologous blood is transfused, can you charge 36430 for the transfusion, 86890 for the autologous blood and a P-code for the particular component (ex. RBC, P9021)?

Answer: When autologous blood is transfused in the hospital outpatient setting, the facility may bill for the transfusion service 36430 with the appropriate product code times the number of units transfused. It is incorrect to bill 86890 Autologous blood or component, collection processing, and storage; predeposited as the payment for the product includes the collection processing and storage.

CPT 83890 is billed on hospital outpatient claims only when autologous blood is not transfused. This should be billed on the date that the hospital is certain the unit will not be transfused (CMS instructs hospital to use the date of the procedure or date of discharge). Do not use any “P” codes or transfusion fee codes as the component(s) were not transfused.

Reference

Medicare Claims Processing Manual Chapter 4, Section 231.3

Question: My question is concerning autologous/salvaged blood. We purchase our blood from the American Red Cross (ARC) and when we issue autologous we are billing code 86890. Should we bill for these units using a "P" code such as P9021?

Answer: For autologous units received from the blood centers, such as ARC, which do not charge for the liquid blood, but only processing fees, you should use Revenue code 0390 (or 0391 for Blue Cross/Blue Shield), the appropriate RBC component "P" code (such as P9021 if your autologous RBCs are not leukoreduced) times the number of units transfused, plus the Transfusion Code CPT 36430 (only once per day per patient transfused) when the blood is transfused in the hospital outpatient setting. Do not use 86890 unless your autologous unit(s) was/were not transfused; if not transfused you may bill using 86890 only times the number of autologous units not transfused for that patient.

Reference

Medicare Claims Processing Manual Chapter 4, Section 231.3

Billing Split Units

Question: What is the acceptable billing practice (Medicare) when one splits a unit of blood for pediatric transfusion? One infant may receive several aliquots from one unit of red cells or two children may each receive a half of the same unit. A platelet pheresis product may be divided for several children.

Answer: When you split a component, you bill using P9011 for each split component transfused and CPT 86985 for each splitting procedure performed along with the transfusion code CPT 36430 if the split was transfused. However, the last aliquot left in a component "mother" bag is billed using P9011 for the component only. It would be incorrect to bill 86985 in addition as the last portion in the bag was not "split".

Note that the above instructions are based on Medicare’s guidelines. Since most pediatric patients are not Medicare-eligible, their payers may not necessarily have the same policies as Medicare.

EXAMPLE 1: Adult with volume issues requires splitting a leukoreduced RBC (LRRBC) into two portions. The first approximately 150 mL was expressed to a transfer bag by sterile dock. You would code the first transfusion of transfer split as P9011 plus 86985 plus 36430 (if transfused). The "mother" bag with approximately 150 mL is later transfused to same patient and would be coded as P9011 ONLY and 36430 (if transfused).

EXAMPLE 2: Neonate requiring splitting of LRRBC of 60mL per split. You may designate this unit for one baby and pull several splits from the unit (e.g., four leaving approximately 60 mL in "mother bag"), then you would code each split as above, but not the last portion in the bag.

EXAMPLE 3: Neonate requiring splitting of apheresis platelets into 20 mL aliquots. You pull ten splits for the one patient leaving approximately 100 mL in "mother bag." Code as above, but not the last portion in the "mother bag.”

Reference

Medicare Claims Processing Manual Chapter 4, Section 231.4

Question: I need some assistance in determining the correct coding for split/aliquoted blood products. We are a hospital-based donor center and transfusion service. HCPCS code P9011 Blood, split unit does not reimburse for modifications such as leukoreduction or irradiation. Which is the correct method? For leukoreduced products, is there a way to capture billing for the leukoreduction? And, if it is OK to bill both P codes, is there a written reference?

Also, does the P9011 code require that a specific volume be included in the coding?

Answer: P9011 includes the cost of the "blood component" and CPT 86985 reimburses the cost of the "splitting" (sterile dock, bags, syringes, etc.). No other "P" code should be billed for splitting/aliquoting blood components. The 2007 HCPCS code definition does not require specifying volumes.

This code does not reimburse for other manipulations such as leukoreduction. However, you can bill the irradiation charge separately when applicable.

Reference

  1. HCPCS 2007
  2. AMA 2007 CPT
  3. Medicare Claims Processing Manual Chapter 4, Section 231.4

Question: Should the P9011 code be used when splitting all blood products, i.e. red cells, FFP, and platelets?

Answer: Yes, the splitting (aliquoting) HCPCS code P9011 was intended to be used for all splitting activities of any blood component. It is to be coded with CPT code 86985 for each split except for the last aliquot left in the "mother bag" as this is not a split aliquot. P9011 would be billed along with CPT code 36430 for the transfusion fee if the aliquot was transfused. Code 36420 is billed once per day per patient.

Use P9011 only for the last aliquot along with 36430 if transfused on a different day for the same patient or the first time transfusion for a different patient. The 2007 HCPCS code definition does not require specifying units.

Reference

Medicare Claims Processing Manual Chapter 4, Section 231.4

Question: I have a question regarding splitting plasma products. Should the P9011 code be used as the product code when splitting platelet or plasma products for neonate transfusions? Currently, we are using the specific product HCPCS code and the 86895 CPT code.

Answer: Yes, the splitting (aliquoting) HCPCS code P9011 was intended to be used for all splitting activities of any blood component. It is to be coded with CPT code 86985 for each split except for the last aliquot left in the "mother bag" (as this is NOT a split aliquot) along with CPT code 36430 for the transfusion fee if the aliquot was transfused. CPT code 36430 is used only once per day per patient.

The last aliquot is billed using P9011 only along with CPT code 36430 if transfused on a different day for the same patient or the first time transfusion for a different patient. The 2007 HCPCS code definition does not require specifying volumes.

Reference

Medicare Claims Processing Manual Chapter 4, Section 231.4

Billing Irradiated Units

Question: In the hospital setting, if a patient requires irradiated blood products but did not receive the two units the physician wanted available, can the transfusion service charge for the irradiating of the units (processing) that the patient did not receive?

Answer: If the hospital blood bank irradiates the unit for a specific patient, the facility may bill the patient for this service using CPT code 86945 Irradiation of blood product, each unit with Revenue Code 0302. If the hospital blood bank did not irradiate the unit for a specific patient, the facility may not charge for the irradiation.

Reference

Medicare Claims Processing Manual Chapter 4 Section 231.5

Question: If the patient who requires irradiated product did not get the two units of leukoreduced red cells that had been irradiated for that specific patient, I could charge the type and screen and crossmatch and irradiation charge to this patient. If I transfuse the two irradiated units to a different patient requiring irradiated, leukoreduced product, would I charge the second patient for type and screen, crossmatch, red cells-leukoreduced, and irradiation also?

Answer: Hospitals may bill 86945 for irradiation of unused components only if they are certain that the irradiated blood was not transfused. Therefore, the code should not be billed for the first patient if there is a possibility that the unit may be transfused to another patient. The other services may be billed to the first patient, but it would be incorrect to duplicate bill for the same service. The facility may only charge for the irradiation one time. However, the type and screen and crossmatch may be charged for each patient as appropriate.

Reference

Medicare Claims Processing Manual Chapter 4 Section 231.5

Question: If an irradiated unit is not used by the patient the unit was irradiated for and placed back in inventory can that unit be used for another patient where there is no doctor’s order for irradiated unit? We consider it a "value added" product, and give the unit to other patients. We also don't want to waste blood in this climate of shortages.

Answer: You may charge only for what the physician ordered. If the physician did not order an irradiated unit but an irradiated unit was transfused because of inventory management, you may not charge for the irradiated portion of the unit. This is a billing compliance issue and if audited the bill should match the physician order. However, if your hospital Medical Executive Committee has approved a Transfusion Services policy that certain patients will receive “irradiated” components (e.g., neonates less than four months of age), then the Transfusion Services may provide an irradiated component without a specific physician order.

Reference

  1. Medicare Claims Processing Manual Chapter 4, Section 231.7
  2. Medicare Claims Processing Manual Chapter 4, Section 231.5

Billing for Frozen & Thawed Products

Question: We sometimes freeze autologous units for a postponed surgery. Is it acceptable practice to bill the CPT code 86930 (Frozen Blood Prep) to the patient at the time the blood is frozen and then only IF the unit is transfused, bill a P9039 (Red blood cells, deglycerolized, each unit) and the CPT Code 86931 (Frozen blood thawing)? If the units are actually thawed and not transfused, can the thawing CPT code be billed? I have thought that since the description for P9039 does not include thawing and freezing, that this would be OK. There are P codes for LR frozen/deglycerolized products that could not be used this way as they obviously include freezing.

Answer: Since you cannot deglycerolize without thawing, the payment amount for code P9039, Red blood bells, deglycerolized, each unit, includes the “freeze” and "thaw". Therefore, if you are the facility performing the freezing and thawing and deglycerolizing of the RBC and the unit is transfused, bill only the P9039 or P9054.

If you are the facility performing the freezing and thawing and deglycerolizing of the RBC, and the frozen, thawed, deglycerolized RBC is not transfused, bill CPT code 86932 Frozen blood each unit; freezing (includes preparation) and thawing with Revenue code 30X if the blood was frozen for a specific patient.

Reference

  1. HCPCS 2007
  2. AMA 2007 CPT
  3. Medicare Claims Processing Manual, Chapter 4 Section 231.6

Question: Is there a specific CPT code we could use for thawing cryoprecipitate? I see that a CPT code is offered for thawing fresh frozen plasma, but not for cryoprecipitate.

Answer: There is not a specific CPT code for thawing cryoprecipitate, and Medicare’s interpretation of thawing “frozen” blood components (e.g., FFP, cryo) is that the thawing reimbursement is included in the HCPCS component “P” code being billed (i.e., P9012, P9017, etc.)

Reference

Medicare Claims Processing Manual Chapter 4, Section 231.6

Question: I cannot find a P code for fresh frozen plasma by apheresis. If there is one, would you be able to direct me to where I can find it? Or, if there is no P code would it be acceptable to charge off a fresh frozen plasma P code twice for the one product?

Answer: You are correct in that there is no separate HCPCS code for "apheresis" plasma. There really does not need to be a separate code for this component as apheresis plasma is reimbursed as fresh frozen plasma. It is billed as P9017 Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit, as apheresis plasma must be frozen within six hours of collection. This FFP is usually a 200 mL volume. However, if you are obtaining jumbo plasma of 600 mL, then the quantity of P9017 would be "3" or another appropriate multiplier depending on the final volume.

Reference

HCPCS 2007

Question: I've been using P9017 for both FFP collected from a single whole blood donor and for Frozen Plasma collected by apheresis method from a single donor. Should I be using P9059 for WB FFP and P9017 for the FP Apheresis?

Answer: HCPCS code P9059 is reported for WB FFP that is frozen within 8 to 24 hours of collection. The apheresis collected plasma must be frozen within 6 hours, so it will always be coded as P9017.

Reference

HCPCS 2007 Medicare’s National Level II Codes

Question: Is the "thaw fee" still appropriate with FFP units?

Answer: The thaw charge (CPT 86927) should not be billed for thawed units of FFP or cryoprecipitate that are transfused. The HCPCS “P” code, as determined by Medicare, includes reimbursement for thawing these frozen components.

Reference

Medicare Claims Processing Manual Chapter 4, Section 231.6

Billing for Jumbo Plasma

Question: How do you bill for jumbo plasma?

Answer: Although CMS has no guidance related to this specific component, instructions for billing “Service Units” on the UB-04 would apply. In billing for "jumbo plasma," typically the standard of practice is to use revenue code 0390 for CMS (0391 for Blue Cross/Blue Shield), HCPCS code for FFP (P9017) in the hospital outpatient setting, times the quantity of equivalent FFPs charged (one FFP=200 mL) for the jumbo (usually 600 mL), i.e. quantity equals three. You may construct a specific line item(s) in your Chargemaster (CDM) for the jumbo plasma based on your supplier's jumbo plasma volume(s) if more than one size is manufactured using the equivalency rule.

Reference

  1. CMS’ Medicare Claims Processing Manual Chapter 1 – General Billing Requirements,” 100-04
  2. CMS Transmittal 1104, November 3, 2006

Billing for Transfusion Reactions

Question: What is the appropriate billing date for CPT code 86078 Blood Bank physician services; investigation of transfusion reaction including suspicion of transmissible disease, interpretation and written report?

Answer: The date the transfusion reaction workup specimen(s) was collected should be the billed date of service. This includes all services performed in conjunction with the transfusion reaction regardless of date of completion.

Reference

  1. 68 Fed. Reg. 74607, at 74611 (Dec. 24, 2003)
  2. Negotiated Rulemaking: Coverage and Administrative Policies for Clinical Diagnostic Laboratory Services

Billing for Pheresis and Apheresis Service

Question: Is it appropriate to bill for a PRBC transfusion given after a plasma pheresis?

Answer: If this is a reinfusion of autologous RBCs, CPT 36514 Therapeutic apheresis; for plasma pheresis includes the reinfusion.

Reference

CPT Changes An Insider’s View 2003

Billing for Transfusion Services

Question: Is it appropriate to attach a modifier (-91, -59) to the CPT code for a crossmatch (86920, 86921, 86922) when more than one unit is crossmatched on the same date of service?

Answer: It is not necessary to add a modifier to the RBC crossmatch CPT codes when several crossmatches are performed on the same day of service for the same patient. You should use the appropriate CPT code (immediate spin, 37° and/or antiglobulin technique), along with the number of crossmatches and line item date of service.

Reference

Medicare Claims Processing Manual Chapter 4, Section 231.1

Question: We are currently trying to set up a program where we draw some preop patients (who have not been transfused) up to two weeks prior to their surgery date for Type and Screen. We would then use those specimens for possible crossmatch when the patient comes in for OR. Our billing department says they cannot combine encounters more than 72 hours old with the new inpatient encounter when the patient arrives for surgery. Is there anything wrong with performing the type and screen on an outpatient encounter and then ordering the crossmatch on the inpatient encounter two weeks later and transfusing units on the inpatient encounter if necessary?

Is it OK to bill the patient for work done on the same specimen on two different encounters? Are there any Medicare audits that look for a type, screen, and crossmatch to be a care set and therefore would affect our reimbursement of them if we separate them since the inpatient encounter would be part of a DRG whereas the outpatient encounter would not be part of that DRG?

Answer: Patient-specific preparation charges should be billed on the dates the services were provided. Any service provided to a beneficiary within 72 hours of admission falls under the DRG and would be reported on the claim as a "hospital inpatient" Bill Type (inpatient Part A=11X; Part B=12X).

However, the type and screen services are billable as outpatient services if the patient is registered as a "hospital outpatient" Bill Type (Part A=13X), and the type and screen services are performed prior to the 72-hours admission window. Many Transfusion Services bring in outpatients for type and screen 2-4 weeks prior to surgery for preadmission testing (13X). When the patient is admitted as a "hospital inpatient," Bill Type (11X), then the crossmatch, transfusions, etc., are billed as an inpatient for that admission stay.

Reference

Medicare Claims Processing Manual Chapter 3, Section 40.3

Question: In the case where a hospital has a product that has not been CMV tested and performs the antibody test on the unit, do you recommend following the same guidelines as for irradiation? If a specific code exists for a CMV Neg product, should we use the component code, and if no code exists for a CMV Neg component should we bill for CMV Ab testing plus the component? Also, if the patient does not receive the product, can you still bill for the CMV testing or the irradiation?

Answer: CMS has not addressed this particular issue in guidance. However, applying CMS’ guidance regarding irradiated components or frozen and thawed blood products suggests the following. If a patient requires irradiated components and a specific HCPCS code for the product does not exist, it is correct to bill the blood component code for the component received from the blood supplier and if you are performing the CMV antibody test and not the blood supplier, it is correct to also bill the diagnostic antibody screening code 86644 for the CMV screen as an add-on code with the laboratory revenue code 030X.

You would also bill any other CPT Transfusion Medicine code that was appropriately performed and medically necessary on the "component" or "patient" even if the blood component was not transfused.

Reference

AMA 2007 CPT

Billing for Antigen Testing

Question: Is the blood bank able to bill for antigen testing on all the units tested or for just the antigen negative units?

Answer: The CPT description for code 86903 Blood typing; antigen screening for compatable blood units using reagent serum, per unit screened instructs to bill for each unit screened. Therefore, the facility can bill for all units tested to find the antigen negative units. However, if a single unit is tested for multiple antigens, 86903 may be billed only once.

Reference

AMA 2007 CPT

Question: Can you charge for Sickle Cell testing on units for Sickle Cell patients and if you are protecting a patient from other antigens, which may stimulate them to produce even more antibodies, can you charge antigen typings for those units? For example a sickle positive patient who needs products which are sickle negative and E negative due to the patient having Anti-E but we also give K and S negative in order to protect patient in accordance with their phenotype.

Answer: Yes, you may bill for any service performed on a blood component for a patient if it is medically reasonable and necessary. The sickle cell patient protocol is now standard practice to start all new patients (and older patients that are antibody formers) with C, E, K neg (some facilities also do Fya as appropriate). This should be stated in your Transfusion Services policy (SOP) on Hb SX patients. In these cases, you would code CPT 85660 per unit screened and 86905 per antigen/per unit typed. Revenue code is 030X for both.

Reference

AMA 2007 CPT

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