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Billing for Pathogen Reduced Platelets


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We will soon be receiving pathogen reduced SDP platelets and LDVS SDP platelets from our supplier. I need to get billing squared away. P9073 looks like the correct code for pathogen reduced platelets. I do have 2 questions:

1) What code(s) are you using for HLA matched pathogen reduced platelets?

2) Are you using a code to recover the charge from your supplier for the LDVS testing surcharge on SDP and irradiated SDP?

Thanks!

 

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Our primary vendor is only adding an increase to the normal platelet charges for LVDS so I just have our revenue cycle team update the pricing and still use the P9035 code.  However, our secondary vendor (for platelets only) has multiple billing codes so I will have one for PLATELETS, PHERESIS, LEUKOREDUCED, one for PAS PLATELETS, APHERESIS, LEUKOREDUCED, one for PLATELETS PHERESIS PATHOGEN REDUCED, and one for LARGE VOLUME DELAYED SAMPLING PLATELET all using P9035 except the PRT which is P9073. 

We irradiate in house so we have a separate procedure code using CPT 86945.  We use that even if our irradiator is down and our vendors are doing the irradiation.  

HLA matched platelets we use P9052.  You should be able to use that same code for SDP and PRT units.  I didn't see a code specifically for HLA matched PRT last week when I figured out my billing.  

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Pathogen reduced platelets are treated with a Cerus Corp. method of using light to activate a photo-activated psoralen compound that cross links DNA and RNA, thus making it impossible for cells to replicate, and, more importantly, viruses, bacteria and fungi to replicate. Thus the risks of bacterial infection after platelet transfusion become near zero.  Increases the cost by about $150 from your blood supplier.  Saves the occasional life threatening post-transfusion bacterial septic infection, and may reduce line infections too I'd guess.

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Should mention that Terumo has a similar process that is licensed in Europe using riboflavin.  Both Cerus and Terumo have licenses for whole blood platelets but for some reason these have not been introduced in the USA, so only apheresis platelets are pathogen reduced at present.  Which makes little sense from a resource or cost standpoint.  There are no clinical advantages to pathogen reduced apheresis platelets over whole blood platelets and apheresis platelets carry a greater risk of acute lung injury due to the five fold increase in plasma from a single "dangerous" donor.

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