Charging for multiple antibody panels

[BB1956]

Often we have to perform 2 or 3 panels including a selected cell panel while working up a patient's antibody. Currently we only result the antibody ID which has a bill code for one panel. Any ideas on how to reflect actual cost as well as record workload for productivity would be greatly appreciated.

[Malcolm Needs ☆]

Within the NHSBT, we have a simple charge for the use of a single panel (plus a few cells for, say, confirmation of an anti-E present with an anti-c, where we would use an R1Rz).

We have a complex charge where we have used more than one panel (and, possibly, some rare cells, such as Kn(a-), McC(a-), U-, Kp(a+b-) etc), but we also have a complex charge (same price, by the way) where we use multiple panels and very rare red cells (such as Oh, Rhnull, MkMk, En(a-), Ko, Er(a-), etc). There is talk tht this latter complex charge may attract a premium, but this is not so at present.

[adiescast]

We charge per panel or partial panel. A panel is considered to be 10 to 12 cells; a partial panel is 3 to 9 cells. We have billing codes for each of these and then charge in multiples. The antibody ID bill covers the first panel. So if we ran 14 cells, that would be billed as the antibody ID plus a partial panel. If we ran a panel and then ran the panel with enzymes, that would be billed as the antibody ID plus an extra panel.

[Malcolm Needs ☆]

If we ran a panel and then ran the panel with enzymes, that would be billed as the antibody ID plus an extra panel.

We run the enzyme panel as part of the routine service (i.e. an IAT panel and an enzyme panel gets charged as one panel).

I think that your way of charging, other than this, sounds really sensible and fair.

:)

[dlv]

we charge one ABID charge for each panel or group of selected cells that we have to test at the IAT phase in order to ID the antibody. We fill out manual charge cards for the additional panels, as we too only result it once, which automatically charges for the first panel.

[Lcsmrz]

I charge for anything performed to determine the clinical significance of the reactivity. But I don't charge for things done that had no impact on the final decision, as in "I wonder if an enzyme panel will help", and it didn't.

[adiescast]

I have to agree with that. My response was based on the assumption that what we performed was necessary for the final result. I had a tech yesterday perform an elution on a baby because they felt the DAT result was too strong to be due to ABO incompatibility with Mom. Well, the eluate showed only ABO incompatibility. The patient was not charged for the elution.

[jcdayaz]

We run the enzyme panel as part of the routine service (i.e. an IAT panel and an enzyme panel gets charged as one panel).

I think that your way of charging, other than this, sounds really sensible and fair.

:)

We also charge for only 1 panel if we resort to our Panel C-- ie. ficin treated panel along with a non treated of the same antigen status. Are we technically running 2panels, yes, but they are designed to be processed together.

[BBK710]

we charge one ABID charge for each panel or group of selected cells that we have to test at the IAT phase in order to ID the antibody. We fill out manual charge cards for the additional panels, as we too only result it once, which automatically charges for the first panel.

So you are charging for each panel that you run even if you run each panel using the same technique?

What CPT codes are you using? CPT code 86870 is described as "Antibody identification, RBC antibodies, each panel for each serum technique." I can't decide if that means you can charge a quantity of 2 for running two panels in gel, or if it means that you can only charge 2 if you run two panels using 2 different techniques.

[dlv]

yes-- we charge for each additional panel or group of selelcted cells, even if it is the same technique.

[BB1956]

Using logic no other business performs work for which they are not compensated. Therefore when you perform 2 panels to ID an antibody and it cost you to identify the antibody, you should be able to charge for the work performed. If this is not the case then the cost of all antibody identification must be increased to compensate for the additional cost of the multiple panels on the few. If we do not use this principle we will quickly not be able to provide the services. Of course what in our field is ever logical when it comes to compensation?

[blut]

Malcolm,

In NHSBT who is charged for testing? Who do they pay and how? Is there a public doc that explains the process? Thanks.

Cheers, Pat

UA: http://www.ualberta.ca/~pletendr/

TraQ: http://www.traqprogram.ca/whatsnew-chrono.asp

TM Blog: http://traq.blogspot.com/

[Malcolm Needs ☆]

Malcolm,

In NHSBT who is charged for testing? Who do they pay and how? Is there a public doc that explains the process? Thanks.

Cheers, Pat

UA: http://www.ualberta.ca/~pletendr/

TraQ: http://www.traqprogram.ca/whatsnew-chrono.asp

TM Blog: http://traq.blogspot.com/

Hi Pat,

The NHSBT charges the Hospital Blood Bank. There are four levels of charge. The most expensive is for tests where we have to thaw out really rare red cells (or use really rare antisera - or both) to prove specificity (such as the anti-U+M I had last month). The cheapest is for antibodies so common (such as anti-D) that they should have really sorted them out themselves!

Each Hospital Blood Bank is actually billed by our Finance people, and the Hospital Blood Bank is "given" a certain amount of public money every year to pay for everything they use (including our services). If they run out of money, they still get the services, but the manager gets a bit of a telling off (unless, of course, there are exceptional circumstances, like a major incident).

If there is a public document explaining it all, I'm afraid that I have never seen it, and would not know where to find it! Rashmi (RR1), Steven Jeff, Steve Wiltshire or Fluffy agglutinates (amongst others) may have a better idea than do I.

:confused::):confused:

[blut]

Thanks, Malcolm. Can I assume that NHSBT acts as a reference lab for hospital transfusion services and it is typically only antibody identitification and other complex testing they pay for? Or does NHSBT perform all pretransfusion testing for some small labs that act as dispensaries of blood (no on-site testing)?

For interest, in Canada Canadian Blood Services (CBS) performs such testing free of charge to the user. However, most smaller facilites are part of a health region and use their region's central transfusion service laboratory as their reference lab. Also, often it is the central transfusion service that receives blood from CBS and then distributes it to smaller labs, which may or may not do basic or complex pretransfusion testing.

As an aside, I loved your "Lax Terminology" article in April's Bloodlines and CPD News. What a good publication.

Cheers, Pat

UA: http://www.ualberta.ca/~pletendr/

TraQ: http://www.traqprogram.ca/whatsnew-chrono.asp

[Malcolm Needs ☆]

Thanks, Malcolm. Can I assume that NHSBT acts as a reference lab for hospital transfusion services and it is typically only antibody identitification and other complex testing they pay for? Or does NHSBT perform all pretransfusion testing for some small labs that act as dispensaries of blood (no on-site testing)?

For interest, in Canada Canadian Blood Services (CBS) performs such testing free of charge to the user. However, most smaller facilites are part of a health region and use their region's central transfusion service laboratory as their reference lab. Also, often it is the central transfusion service that receives blood from CBS and then distributes it to smaller labs, which may or may not do basic or complex pretransfusion testing.

As an aside, I loved your "Lax Terminology" article in April's Bloodlines and CPD News. What a good publication.

Cheers, Pat

UA: http://www.ualberta.ca/~pletendr/

TraQ: http://www.traqprogram.ca/whatsnew-chrono.asp

Yes, we do only do Reference work, but, in the South of England we do perform cross-matching on DAT positive patients if requested and if there is free auto-antibody in the plasma, but in the North and Midlands of England the NHSBT tends to do much more cross-matching for the Hospitals, even for fairly basic antibodies.

Thanks for the comments about the article.

:)

[jcdayaz]

My turn to throw a "Does anyone remember this" question out there for all of you. (Sorry, I'm too sleepy to start a new thread!)...

We were having a debate at work yesterday about the reason the R2R2 cells have a stronger expression of the D antigen. Is it the size of the C versus E molecule, or is it the number of them, or is it the proximity of the C antigen to the D antigen on the red cell producing a "blocking effect"?

Anyone remember?

[Malcolm Needs ☆]

My turn to throw a "Does anyone remember this" question out there for all of you. (Sorry, I'm too sleepy to start a new thread!)...

We were having a debate at work yesterday about the reason the R2R2 cells have a stronger expression of the D antigen. Is it the size of the C versus E molecule, or is it the number of them, or is it the proximity of the C antigen to the D antigen on the red cell producing a "blocking effect"?

Anyone remember?

It is, as far as I know anyway, purely a matter of the number of antigen sites expressed (from 15, 800 to 33, 300), with the next most densely populated (leaving aside deletions, such as -D-/-D-) being R1R2 (which, of course, has the R2 haplotype anyway).

That having been said, there was a paper written way back in 1960 by Carolyn Giles (Giles CM. Survey of the uses of ficin in blood group serology. Vox Sang 1960; 5: 467-471.) which looked at the relative strengths of the D antigen with different Rh haplotypes, and there is no doubt that the presence of the RHC gene does affect the number of D antigens expressed on the red cell surface, both in the cis and trans position, but this is at the genetic level, rather than at the mature polypeptide level. What it cannot be, however, is the size of the C versus E molecule, as both antigens are expressed on the same polypeptide molecule.

I hope that helps a bit.

:):)

[jcdayaz]

It is, as far as I know anyway, purely a matter of the number of antigen sites expressed (from 15, 800 to 33, 300), with the next most densely populated (leaving aside deletions, such as -D-/-D-) being R1R2 (which, of course, has the R2 haplotype anyway).

That having been said, there was a paper written way back in 1960 by Carolyn Giles (Giles CM. Survey of the uses of ficin in blood group serology. Vox Sang 1960; 5: 467-471.) which looked at the relative strengths of the D antigen with different Rh haplotypes, and there is no doubt that the presence of the RHC gene does affect the number of D antigens expressed on the red cell surface, both in the cis and trans position, but this is at the genetic level, rather than at the mature polypeptide level. What it cannot be, however, is the size of the C versus E molecule, as both antigens are expressed on the same polypeptide molecule.

I hope that helps a bit.

:):)

I knew I could count on you Malcolm! That was my stance in the debate. I guess I just wanted some reassurance! The whole "size of..proximity of.."didn't seem at all valid to me and nothing close to what I was taught.

Thanks!