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Charge for products not transfused?


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Does anyone charge for products such as FFP, PLT's and Cryo that are ordered and not used, or does the hospital just eat the fees for the units?

This is happening way too much.

1. Ordered to be transfused before procedure, FFP thawed, procedure cancelled. FFP wasted.

2. Patient signs Consent, nurse picks up PLT's, patient refuses. Our blood supplier does not credit for Platelets. You order them, you're stuck with them. A Pheresis is $600

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If we cannot use the thawed product for another patient, and it expires then we loose $$ on those products. As for apheresis products, when we have product that is about to expire, we contact our blood center and they make an attempt to move the product for us. They will only allow us to return the product when they have a home for it.

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Yes, we are in the same boat - our blood supplier only allows us to return PLP's with a 24 - 48 hour outdate. We would eat the cost if they could not pawn them off on some other site that had give orders. FFP we would again eat the cost if we couldn't use them for another patient or find another facility that could.

We do track this financial loss and try to make the Doc's feel a little guilty about it anyway?!

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I feel your pain. We do have return privledges for PLTs, but if we keep one because there are orders to give, then not used, we eat it.

You can't bill the patient. You can charge the FFP thawing fee (CPT 86927) if the FFP is not given, but that is a tiny reimbursement.

I keep track of wasted products and $$ lost. I give a report to quality care managment each year. Our cost of wasted product runs about 2% of total blood costs. (If I started to notice a real problem from one doctor, I'd call them to let them know sooner.)

Linda F

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You could consider converting your thawed FFP to 5 day thawed plasma. This is relatively easy to do and would save you a lot of wastage of this product in the above situations. Thaw it in advance, label it thawed plasma immediately (saves the extra step of labeling and relabeling from thawed FFP to thawed plasma, or possibly forgetting to relabel and issuing a "misbranded" product) and keep in the fridge for 5 days. Plenty of clotting factor for general usage in the sorts of patients needing plasma--trauma, liver, massive transfusion in surgery, etc.

When we did this at my former hospital, our thawed plasma wastage went from around 3% to less than 0.5% the first month we did it and stayed there for over 4 years.

Not much I can offer in the way of help for those pesky platelets!

MJD :cool:

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CMS allows the charging for splitting, pooling, thawing of product in preparation for transfusion. If the unit is not transfused, you cannot charge the standard product fee. See the "Comprehensive Guide to Billing and Reimbursement Update" pages 16 & 17 for specific examples on how to code and bill. Just be careful not to charge the splitting fee with the remaining unit of a split ( only 1 split fee can be charged if unit was divided in half, only 2 split fees if divided in thirds).

We use one on one education about the platelets - making sure the physician understands that they must be transfused. Our supplier works with us to redistribute in cases where the patient expires or is transferred before shipment arrives.

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I had always charged a separate thaw fee for FFP and Cryo but I recently heard differently.

I was told CMS addressed this in their September 29, 2006 update letter by clarifying that "if a HCPCS code descriptor reflects that a product is frozen, then the descriptor, by inference, also reflects that the product is thawed, since blood cannot be administered in the frozen state. Therefore, if a blood product is transfused and the descriptor for the appropriate P code includes "frozen", the hospital must bill the P-Code for the blood product but may not bill a freezing or thawing CPT code."

Now I am not sure which is the appropriate way to charge.

Any help will be greatly appreciated.

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We do not thaw an FFP, even if ordered STAT until the RN calls --and they must call us, we do not call them--to tell us it will be transfused within 30 minutes. We also have a Blood Committe made of DR's, pathologist and BB supervisor, who look at the monthly report of waste and usage in an effort to keep product loss down. It helps having the physicians understand that certain products can not be set up until patient is actually being transfused.

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I have a related question. We are a rural hospital who frequently transports patients to the big city by air. We do get orders to crossmatch and box units for transport so that units will be available for transfusion in transit. Although we tried to set up systems to learn the final outcome, there was little information returned to us and we often don't know if units were transfused or not. I've considered these units as patient billable....is the hospital responsible for eating the charges on transported units?

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CMS specifies which HCPCS codes allow separate billing for freezing and thawing services. However, it also states that "hospitals may bill the appropriate freezing/thawing CPT code(s) if a frozen/thawed blood product is not transfused, regardless of whether the product's HCPCS code is included in the list...In this scenario, hospitals may not bill the blood product P-code or the transufsion CPT code can be billed. For unused frozen/thawed blood, OPPS providers should bill the appropriate freezing and/or thawing CPT code(s) on the date when the hospital is certain the blood will not be transfused. "

Keep in mind, this terminology is for the Outpatient Setting, since all Inpatient billing is DRG driven. And... I'm a simple blood banker, not a coder/billing specialist.

We usually can reallocate a thawed plasma to another patient within the 24 hour expiration, so have very little waste and do not worry about the above scenario.

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We have the transport issue you talk about and it's a whole lot of fun trying to get information out of the receiving hospital sometimes. Some facilitites we may transfer patients to refuse to acknowledge that the patient ever came in with any product at all. Since they "don't receive the product", they tell us that everything is our problem and has nothing to do with them. We figure on eating the charge in cases like this.

If we transfer to a facility who uses the same blood supplier as we do, we can transfer the products we send out packed in a box to the receiving hospital. We get credited for the product by the supplier and the receiving hospital gets billed for it. If the patient rolls out the door with a unit or units hanging, we bill for those. We like it better if they send them out with the product running:D! We also ask them if they are really really sure they need to send blood with the patient - it's a short flight and there is not much time to run blood.

I don't think there is any good way to deal with this unless your facility has its own life flight and can get the coolers with product back.

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  • 2 months later...
  • 1 month later...
  • 1 month later...

Are coagulation factor products treated the same as blood products. If they are reconstituted but not used, does the hospital have to absorb the cost? We have asked our billing folks about this and are awaiting their response. Until we hear otherwise, we will not generate a charge.

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  • 9 months later...

I'm wondering how other facilities handle this billing issue:

A patient comes in for pre-op bloodwork, including a type and screen and orders for 2 units packed cells. The patient is banded and all work is ordered,done on the pre-op acct.

After surgery, the patient goes to the floor and the next day they want to transfuse.

It's my understanding that the type and screen and XMatch need to be billed to the pre-op acct and the actual product given needs to be billed to the inpatient acct.

We have Meditech and I am trying to figure out a way to set up automatic billing without having to manually remove the product from the pre-op acct and add to the inpatient acct.

Any ideas?

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:)You are correct in the way it needs to be charged. Our preadmit patients have 2 accounts, one for the preadmit testing and one for the charges as an inpatient. Our Cerner computer aloows us to select the appropriate encounter.

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  • 1 month later...

You can charge a thawing fee on FFP and cryo thawed and not issued, but not for the product if not given.

This information can be found in Chapter 4 of the Medicare Claims Processing Manual, section 231.6 including a detailed list of all blood/blood product codes with freezing/thawing billing instructions. Link to the Claims Processing Manual Chapter 4:

http://www.cms.hhs.gov/manuals/downloads/clm104c04.pdf

The same billing guidelines apply to blood and blood products regarding irradiation of blood (§231.5) and autologous processing (§231.3).

Mary

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I'm wondering how other facilities handle this billing issue:

A patient comes in for pre-op bloodwork, including a type and screen and orders for 2 units packed cells. The patient is banded and all work is ordered,done on the pre-op acct.

After surgery, the patient goes to the floor and the next day they want to transfuse.

It's my understanding that the type and screen and XMatch need to be billed to the pre-op acct and the actual product given needs to be billed to the inpatient acct.

We have Meditech and I am trying to figure out a way to set up automatic billing without having to manually remove the product from the pre-op acct and add to the inpatient acct.

Any ideas?

Our Preop patients are TS only. Then when they come in the day of their procedure, the orders are entered (by the amb surg dept) for the products requested on that day's admission. The date of surgery is considered DAY 1 for the preadmission TS sample (even though it's entered for the actual collection date) and that specimen's crossmatches reflect that date and will have a 72 hour life at that point. We have Meditech also (:mad:). If the patient is not crossmatched that day and then the next day on the floor they order a unit, the specimen is now 1day old and we'll backdate the product order to reflect that, etc. Our preop TS specimens are good for 14 days. If the surgery is done on the 14th day, then the specimen could not be used on the 15th day and a new TS will have to be done. If the patient was recently transfused or pregnant, then a new TS specimen will be requested on the day of surgery, a new IAT performed as a confirmation that no previously undetected antibodies have formed, but all off the books (no order or charge) but results documented in BB.

We in BBk, having a copy of the surgery schedule and the signed preadmission testing document signed by the patient which notifies us of any recent transfusions or pregnancy. If the patient has an antibody, we automatically crossmatch 2 units the day before to save time.

Also, the day before surgery we call the ambulatory surgery department to notify them of any patients that require a 2nd specimen for ABO confirmation. When the patient comes in the next day, they obtain the specimen when they start the IV etc.

We also scan the surgery schedule for any patient that may not have a TS yet are having a procedure that normally warrants one. We'll notify the amb. surg. dept. as a courtesy that they may need to order one.

It's worked out quite well for us. I hope this makes sense, it's a rather simple system that appears complicated when describing it.

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