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Billing for extra testing not reported


Mabel Adams

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US Scenario: patient has a positive gel screen so a panel is done which doesn't key out to anything. A repeat screen in PEG or 3% cells converted to 0.8% in gel comes out negative.  So we conclude that it is probably an antibody to gel diluent.  

We can charge for the repeat screen by a different method, but does anyone charge for the antibody ID?  If so, do you feel you must report an antibody ID result?  Then what?  Negative?  Inconclusive?  Antibody to reagent? We wouldn't want anything that would interfere with future electronic crossmatch in our BBIS.  Similar issues can arise with other tests sometimes.

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My facility seems to have a similar process in regards to gel screens. The only difference is that we perform the repeat screen before* proceeding to panels on patients with no previous history. Only when the repeat is positive or there is history is the panel performed. That ended up being a workflow decision that took some time to resolve, but moving to the performance of the tube screen first prevented gel-sensitive positives (that are only going to result as negative on panel) going straight to panel and getting fully worked up.

As far as our result entry, positive gel screens do trigger an ABID test bar that has to be resulted. Our repeat screens in tube with negative reactions are resulted as No Antibody Detected (NAD), which keeps them EXM eligible. If the repeat screen is positive, and the workup moves to a panel, the ABID is resulted as the result of the panel. The repeat screen is billed as a "subsequent antibody screen with enhancement media," and we have two billing codes for standard panels (one billing for panels with 3 or less cells, and one billing for panels with 4 or more cells).

 

TL;DR:

  1. Perform gel screen
    • If positive...
      • Does the patient have a history of antibodies?
        • YES... proceed to panel rule-out.
        • NO... proceed to step 2.
    • If negative... result as negative.
  2. Perform PEG screen
    • If positive... proceed to panel rule-out.
    • If negative... result as NAD.

Basically, the NAD to me seems like a dummy negative result to file. It means like a, "hey we did some reference work to see if there was anything, but there wasn't, but because we did a little more than just routine we can't just call it negative." Oh well.

 

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We bill the antibody ID and the second screen. Our primary method is solid phase. If the screen is positive we run the panel. If the panel is all positive/inconclusive we run a screen with PeG (and/or LISS and/or saline) to see if we can resolve the screen. We have seen antibodies in solid phase that are undetectable in tube, so that's why we run the panel. How we report it depends on what we see w/ the panel and screens.

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  • 10 months later...

At my facility as soon as the ABID is resulted it is charged. If the scenario you mentioned happened to us the ABID would be reported out as a "see note". The way our computer system is set up a "see note" allows for a computer xm. Only down fall with this policy the patient is eligible for a preadmission workup. 

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