Billing split products

[Kathy]

What is the proper procedure for billing products that are split (ie. red blood cells, FFP, platelet pheresis)? We have ISBT and our splits have the appropriate letter designations. Since I really know nothing about billing, please be detailed with the answer. I want to know what know what codes need to be billed and if the split units are billed, what the charge is compared to the whole unit charge. Is it ever appropriate to bill a whole unit if a split unit is transfused? I am not concerned about the charge for splitting the unit...only the charge for the product itself. I would very much appreciate any answers.

[Deny Morlino]

I am not able to be of any help as far as the ISBT codes as we have not made the transition yet. As far as the splitting process goes, there will always be one more unit charge than there are charges for splitting. For example a pack cell unit is split twice into a total of 3 splits. This would incur two splitting charges and three unit charges. In the ISBT system the splitting charge is probably included in the description (a guess on my part). The same scenario above in ISBT would mean two units described to include the splitting process and one unit described that does not include the splitting process. This may not be very clear as I am describing it and hopefully others using ISBT will chime in. To answer the whole unit question I would say billing for the whole unit when a split is administered is inappropriate. ISBT users please fill in the blanks!!

[L106]

I'm not sure we're on the right track here.

I interpreted Kathy's question to be concerned with such issues as: "How should I charge a patient who only takes the first half of a unit (and the second half isn't used)?" Or, "How do a charge Pt #1 who takes a third of a unit, then a second third of the unit, then Pt #2 takes the last third of the unit?" (Kathy, am I misunderstanding your question?)

Donna

[Kathy]

I am now clear on the fact that split units must be billed and that you can charge the splitting charge for every part except the last part. How do I determine the split unit charge? I ran some numbers and determined that, on average, we split a platelet pheresis unit into 2.7 parts, but only transfuse 2.2 parts. Would I take the whole unit charge and divide it by 2.7 to get my split unit charge?

[Deny Morlino]

When attending the supplier meetings on this sort of subject the recommendation is always to cover your expenses by wrapping everything into the average price charged for a product. This includes such things as storage of the product and any manipulation necessary to prepare the unit for issue. I would likely divide my normal unit charge in half for a split as your use is colser to 2 than 3 and that would cover you 2.2 parts figure you have come up with. Don't leave anything on the table as blood bank is already a cost center anyway.

[sgoertzen]

If your computer is set up for it, you can also use volume billing. We have ours set up this way, so that the computer bills a certain amount for each mL in the split product volume. We used to do it by averaging the number of splits made per product and assigning that adjusted split cost to the various split product codes. But when we moved to ISBT, the product codes no longer changed when we used the "Make Aliquot" routine to split the product (at least not in our computer system - MediTech). So we decided to move to the volume billing at that point. Our billing department hasn't seemed to have any problems with it, and it does make more sense that an aliquot of 10 mL would cost less than an aliquot of 100 mL. We are a children's hospital, so we split products all day, every day.

[GilTphoto]

We only split about 10 units a year. We split them into 4 bags, but 98% of the time, only issue 1 and throw out the remaining 3. We charge for the full unit, but no splitting fee. If a second bag is issued, we credit the second charge.

Don't know if this is right, but was the only way to recover our costs.