Billing for Antigen Typing

[msmc]

I was hoping I could get some feedback on charging for antigen typing. Currently I bill the patient per antigen typed (corresponding to the patient's need) per unit ordered. For example the patient needs 2 E negative units we bill for 2 antigens. However, I recently found out that some hospitals are billing for the the antigen according to the number of units screened regardless of the number of units ordered by the physician. Could anyone offer some guidance as to which is correct?

Thanks.

[mhc]

The other hospitals have it correct. You charge CPT 86903 (if using reagent antisera) times the number of units screened, regardless of the number of antigens screened for. So if your patient has anti- C, E, K and you screen 10 units for the 3 antigens, you charge 10, not 30.

[Ann Viernes]

mhc is correct according to CMS rules. Why is it, then, that the reference labs charge per antigen?

[David Saikin]

The reference lab is charging you (the hospital) usually, not the patient.

[Ann Viernes]

The reference lab is charging you (the hospital) usually, not the patient.

My point was that the reference lab bills the hospital per antigen, but the hospital may only bill the patient per unit, no matter how many antigens. A money losing prospective.

[estiner]

Are you sure about the CMS rule? My understanding from the AABB session on Reimbursement is that you can charge for each antigen tested - so 3 antigens per unit and 10 units testing should permit 30 antigen charges, not 10.

[mhc]

I copy below from the Reimbursement FAQ on the AABB website:

Billing for Antigen Testing

Question: Is the blood bank able to bill for antigen testing on all the units tested or for just the antigen negative units?

Answer: The CPT description for code 86903 Blood typing; antigen screening for compatable blood units using reagent serum, per unit screened instructs to bill for each unit screened. Therefore, the facility can bill for all units tested to find the antigen negative units. However, if a single unit is tested for multiple antigens, 86903 may be billed only once.

Reference: AMA 2007 CPT

[Bill]

mhc has quoted AABB which references a 2007 AMA reference, but the REAL ANSWER lies with each area's local Medicare intermediate. We have less than 50 days to be ready for the 2009 reimbursement changes (Mar 1) so quoting 2007 FAQ's may not be accurate anymore.

[estiner]

Interestingly I read that exact same CPT description to state each antigen typing performed per unit.

[mhc]

mhc has quoted AABB which references a 2007 AMA reference, but the REAL ANSWER lies with each area's local Medicare intermediate. We have less than 50 days to be ready for the 2009 reimbursement changes (Mar 1) so quoting 2007 FAQ's may not be accurate anymore.

I did not see any changes to that particular CPT code in the 2009 updates. And while the FI's may have the last word on reimbursement, in my experience they rarely are less restrictive than the AMA CPT guide. Usually, they are just unprepared to handle the changes in the time frame that CMS wants. But by all means, check with them.

[BBDW]

Our hospital just went through this billing issue. It is correct that we can only have one antigen typing charge per unit regardless of the number of antigens. However, when antigen typing the patient, it is permissable to bill per antigen. Go figure...

[bbbirder]

But don't forget, you can bill for each unit screened, not just the antigen negative units.

Linda Frederick

[Mabel Adams]

Blood centers type their donors and keep a record. When they need antigen negative units, they often only have to confirm antigen types of donors already on record for being negative. Transfusion services can't do that. I would guess that when blood centers do have to screen for antigens without any history, they do it in batches of the commonly needed phenotypes. This would all make it pretty hard for them to bill us for each unit tested. Since they don't have to bill the patient, they don't have to play by Medicare rules.

So, if you bill 6 Ag types for finding 2 Rh neg units neg for E, C & K, how will CMS know whether you found several units that were antigen positive or charged for all antigens tested on both units? Most computer systems don't keep track of antigen typing by batches do they?

[Mary**]

Good point!

[BBK710]

How do you charge when you order antigen negative units from ARC? They bill per antigen but they also charge a Screen 1-10 or Screen 11-20 etc. Can we only charge for one antigen for each unit that we order? This question was raised at a reimbursement seminar that I attended but the "experts" couldn't answer it.

[Townsend]

Is anyone using the CPT code 86905 instead of 86903? The CMS comments on 86903 allow one antigen screening per unit screened, but what about using 86905? There was an AABB reimbursement question about how to bill for phenotypically matched blood for sickle patients (ie C, E, K neg units) that said to charge 86905 times 3.