Using Meditech C/S 5.64 to bill for antigen typing

[hmust1]

Does anyone know if there is a way to charge unit antigen typing (regardless of infusion) directly to a patient account using Meditech C/S v. 5.64?

(Right now we pull a weekly "BBK History Audit Log" for antigens only and bill each patient manually by adding a charge type test to the XM requisition. However, it's sometimes difficult to tell which patient the antigen typing goes with, especially if we have multiple patients with the same antibody receiving blood at the same time. And it frequently results in late charges appearing on patient accounts.)

Any other suggestions even if there isn't a way to do it automatically?

Thanks!

[Lcsmrz]

We also use the charge-type test for charging Ag Typing in Meditech CS v5.64, but I add them the following working day when reviewing transfusions on the Patient Master Log.

I charge an Ag Typing on each transfusion, unless we get some special units in from the blood center for one patient. We rarely screen shelf units for an antigen ...

[Bill]

It has been awhile since I used Meditech, but you should be able to write a rule attached to crossmatch that would add Ag typing if there is an antibody present. This could be on all AHG crossmatches that it would look for antigen. IS crossmatches would not be appropriate for antigen typing for patients with antibodies.

[Dr. Pepper]

We're not up to that version yet, but we have test ATP (antigen typing on patient) built to record the typing results. We order it in requisition tacking it onto the type and screen req, then we have a bill only test (ATPBILL) that we order and change the test count to the number of typings we did. The ordered number of the appropriate CPT bangs off on the BAR fiscal side. It's all manual, but really doesn't take much time - you're probably going back to requisition to order and result an antibody ID anyway.

[rrcc1974]

We are MT 5.57 and use a Customer Defined Screen that asks "Has UATC been ordered?". The UATC is added to the patient's requisition. UATC is the Unit Antigen Test Count and we change the test count to the number of typings we did. Similar to Dr.Pepper.

[mollyredone]

I was wondering about the "legality" of Ag charges. If you type 10 units and find 5 negative for the ag; but the patient only needs 2 units, do you just charge typing for the 2 Ag neg units they need? What about the other units that are negative? Can you charge them to another patient that needs that same Ag negative unit? Any references stating what charges you can take?

Thanks, Mollyredone

[Dr. Pepper]

Suzanne Butch moderated an AABB teleconference a few months ago on billing and codes. If you antigen type a patient, she said to use CPT code 86905 and bill for each antigen tested. If you antigen type donor units, however, you can only bill once per unit, no matter how many antigens you test for. You can, however, bill for the number of units you had to type to get what you needed for a patient. Once a donor unit has been typed and billed, if unused you can't bill another patient for the same antigen typings, only for different ones that haven't been tested yet. The CPT code for typing donor units was 86903 but has been changed to 86902 for 2011.

There is the potential for abuse (screening and billing 100 units for K to find the 2 you need - and 88 others). I ask my techs to do what they should be doing anyway and calculate how many units they need to screen. Let's say the patient has anti-Fya + E, so you'll about need 10 units to find 2. Hey, most patients are DRG anyway and it doesn't matter what you bill.

[Dr. Pepper]

An addendum - I had it verified by Suzanne Butch yesterday that besides changing the CPT code for typing donor units to 86902, the # that you can bill will been changed to the # of antigens tested of the total # of units you had to screen. Your patient has anti-Fya + E and needs 2 units. You type 10 units for Fya, find 3 negative, type those 3 for E, find 2 negative. You can bill for all 13 typings you did, not just one charge per unit. This is effective 1/1/11.

Edited December 23, 2010 by Dr. Pepper

[mollyredone]

Thanks a lot Phil! Will there be a printed reference for that to follow?

[Dr. Pepper]

Here's a link to the CMS website: https://www.cms.gov/ClinicalLabFeeSched/Downloads/CY2011-CLFS-New-Test-Codes.pdf

Scroll down to CPT 86902. It gives you more info than just the new # in the new 2011 CPT book.

Suzanne said she asked the AABB to send out a notice but she hasn't seen one yet.

[Orr Austin]

It is now February, has the AABB put out any statements regarding this new billing issue? We could use some definitive answers from them.

Thanks !

[Dr. Pepper]

None that I am aware of...

[Eagle Eye]

do we need to wait for AABB? I do not think so...we already implemented code 86902...

[Dr. Pepper]

So have we.

[SMW]

Since the rule is a CMS rule not an AABB regulation, CMS is the definitive response..........

[BankerGirl]

Does anyone know if there is a way to charge unit antigen typing (regardless of infusion) directly to a patient account using Meditech C/S v. 5.64?

Any other suggestions even if there isn't a way to do it automatically?

Thanks!

We perform this automatically by incorporating reflex testing. If the antibody screen is positive, it reflexes a test called "AG TESTING," to which the tech enters the number of antigens tested. Then we built corresponding Order Groups to bill the number of antigen typings based on the result to the AG TESTING test. Basically, they say if AG TESTING = 3, bill charge x 3, if AG TESTING = 4, bill charge x 4, etc. I would be glad to send you the rules if you need them.