Billing for transfusion reaction workup

[Lecia Guill]

Does CMS allow billing for the component tests in a transfusion reaction workup in the U.S.?

[JoyG]

Absolutely.  We charge for every test performed working up a transfusion reaction.  i.e Post transfusion DATP, repeat ABORh, ABSC and if positive, post DATG, DATC, ABID, pre DATG, DATC, and repeat crossmatching, etc.

[John C. Staley]

4 hours ago, JoyG said:

Absolutely.  We charge for every test performed working up a transfusion reaction.  i.e Post transfusion DATP, repeat ABORh, ABSC and if positive, post DATG, DATC, ABID, pre DATG, DATC, and repeat crossmatching, etc.

Just curious but does your billing indicate that these charges are specifically for testing in regards to a potential transfusion reaction? 

I had an insurance auditor deny a claim for crossmatching when the patient was not transfused on the grounds that, obviously the crossmatch was unnecessary because the patient used no blood.  The procedure was for a TURP and at the time the usual order was for 6 units.  Very rarely did a patient not use at least a couple of the units.  

[JoyG]

I would refer the insurance auditor to Medicare Claims Processing Manual Chapter 4, Section 231.7.  It's right on CMS website.  If your Med Exec committee and hospital policy was to crossmatch 6 units in preparation for that surgery, then that was the patient-specific preparation charges that can be billed.

231.7 - Billing for Unused Blood

(Rev. 1487, Issued: 04-08-08, Effective: 04-01-08, Implementation: 04-07-08)

When blood or blood products which the OPPS provider has collected in its own blood bank or received from a community blood bank are not used, processing and storage costs incurred by the community blood bank and the OPPS provider cannot be charged to the beneficiary. However, certain patient-specific blood preparation costs incurred by the OPPS provider (e.g., blood typing and cross-matching) can be charged to the beneficiary under Revenue Code Series 30X or 31X. Patient-specific preparation charges should be billed on the dates the services were provided.

Edited March 20, 2019 by JoyG

[John C. Staley]

JoyG This happened over 20 years ago.  I would imagine things have changed since then and to be honest I never did hear if the insurance company paid for it or not.  Was just using it as an example.  You didn't answer my question, does your billing indicate that these charges are specifically for testing in regards to a potential transfusion reaction?