Billing for Transfusion RXN Workup

[KKidd]

We currently do not charge the patient for a transfusion reaction workup. How do you charge the patients? I am in dicussions with my manager and need some guidance.

[Eagle Eye]

Bill the patient for the tests we do. Our physician also bills separately under physician only CPT code 86078.

[Likewine99]

We have a charge attached to the workup. I think the previous supervisor figured up the minimum amount of time and or reagents involved in the least complicated workup and used that as the price.

We have a nsg orderable code. After the pathologist reviews it we enter a canned comment that denotes if a rxn occurred.

[BB1956]

I know it has been some time since you asked this question about charging for the transfusion reaction workup. I too am in VA and have the same issue. What did you ultimately decide about charging the patient?

[Bill]

In the US, "charging the patient" is a misnomer in >90% of cases. We really are accepting a fixed reimbursement from the contracted health insurance carrier; whether it be Medicare, Medicaid, or private insurance. It is important though to show these CPT codes so that the lab charge to reimbursement ratio is correct. This is the only way to force the reimbursement people to pay more for lab services.

[Stoogiesfreak]

We do not charge for reaction workups.

[AMcCord]

We manually bill for tests performed.

[Deny Morlino]

We submit billing for the testing performed to investigate the reaction as testing will vary depending upon the situation. As Bill indicated, whether we are reimbursed and for how much is determined by insurance, etc. The "billing" effort is to help change reimbursement from one year to the next.

[LaraT23]

Same here with insurance and those lovely medicare DRGs, so billing is really relative. Sometimes I think it should be called a loss statement when it comes to blood bank services. That is unless it is outpatient....

[Deny Morlino]

Blood bank is definately NOT a profit generating corner of laboratory medicine! Aggravating to fell like you are always chasing pennies in the cost cutting battle, and still sometimes falling behind

[adiescast]

We also bill for reaction workups. I am not sure we actually get paid for *anything* we do. I keep waiting for someone to decide that reactions are medically inappropriate events (or whatever that term was that they applied to hospital acquired infections...) and therefore not reimbursable!

[Malcolm Needs ☆]

We do such an investigation for free - if there is a justification for the investigation, whether it is proved to be a reaction or not.

If there is no (reasonable) justification - then we charge.

[tbostock]

Same as aakupaku wrote above.

And, yes, I agree with Deny that BB is a big money loser. I love when administration asks why we were over budget for blood for the month. I usually reply "people bled", then they leave me alone...haha

[adiescast]

Same as aakupaku wrote above.

And, yes, I agree with Deny that BB is a big money loser. I love when administration asks why we were over budget for blood for the month. I usually reply "people bled", then they leave me alone...haha

One of my favorite lines...."Tell Mr. Smith to stop bleeding, he has exceeded his allotment of products!"

[Deny Morlino]

Same as aakupaku wrote above.

I love when administration asks why we were over budget for blood for the month. I usually reply "people bled", then they leave me alone...haha

Do you ever wonder if they think before they ask that question? I try very hard to not be a smart mouth, but it is difficult (VERY difficult) to bite my tongue when such a question is posed.