Electronic crossmatch billing setup

[rcracer09]

I'm in the beginning stages of validating electronic crossmatch (EXM) in my LIS system. One of the items I need to setup is billing for EXM. The CPT code for EXM is 86923, but what cost parameters are you using to determine the unit cost of performing EXM?

Thanks

[Bill]

You do not say where you are from but if your are in US and have Medicare/Medicaid patients: EXM is considered the same as a calculated test like Anion Gap or INR, and cannot have a $ charge to it. You can and porobably should show it on the bill, but the charge must be $ 0.00.

[rcracer09]

Bill, thanks for your input. from California.

[adiescast]

My understanding is that you can bill for tests that have identified CPT codes. We do bill for our electronic crossmatch. We figured a cost per test that included the items we usually include for other crossmatch tests like the unit tag and the rubberband to attach it. The price is far less than what we bill for immediate spin crossmatch.

[tbostock]

Check the Medicare Part B payment schedule; they reimburse "real money" for the electronic crossmatch, so I believe we are allowed to charge an actual fee for it. Less of course than the immediate spin, as adiescast mentioned above.

[rcracer09]

What cost parameters is your hospital using to justify cost or are you using the cost that Medicare reimburse?

[tbostock]

The billing dept uses some formula after we give them the "cost per test" information.

[rcracer09]

What are you using to base your cost per test? Cost of crossmatch cards,cost of printers,etc

[Likewine99]

For cost per test we consider anything used to do the test. Tech time, reagents, tubes, etc. This is hard to calculate down to the bench level.

I wouldn't add in printer costs since you probably use that printer for other things. Labels, cards, that kind of stuff though I would think is legitimate.

For the case of the EXM I would suggest the Medicare reimbursement rate times whatever magic formula your finance dept uses. Get in touch with your reimbursement people, you can't do this in a vacuum, it's a big job.

[rcracer09]

The printer that we're using is dedicated to our Issue/Transfuse tags. Other items such as labels, reports, etc are setup on other printers in our dept. Our Finance and Path Billing dept are involved which is why I put this item out on the Forum just to get other user input.

Thanks for your response. It is greatly appreciated.

[AFiddler]

CMS allows OPPS payment for 86923. $14.93 per unit.