billing for testing to rule out significant antibodies

[amyhlandry]

We use the echo and its not uncommon to get weak reactions in the original antibody screens (as we have all heard). To make certain that these reactions are non-specific and not clinically significant we perform panels on the echo and then additional screen using diffrent technology if required. The anitbodies get reported out as solid phase reactions, non-specific.

A client of ours is refusing to pay for the additional work-up because they feel it is a problem with our methodology. I have argued the point that all methods have downfalls and will always have something to contend against, but they are set that it is not leagl for us to bill for this testing. I cannot really find information for either side. Really new to billing!!- so maybe I just don't know where to look for this information. Any information would be greatly appreciated.

[Auntie-D]

But if you didn't test (and thus didn't bill) and incompatible blood was given and the patient developed an antibody they would be happy with that? I think education may be the key here...

[Deny Morlino]

Agreed. You need to pull out your educators hat and give a mini lesson in blood bank science so the client has the correct basis to make the decision. At the same time be open to their point of view so as not to stoke the fires of a disagreement further. Be ready to offer the information related to the different methods and their drawbacks as well since the client will suggest trying a different method than you currently use. Stick to your guns though as your goal is to provide the safest product and best results for the client's patients. Let us know how this progresses please.

[rcracer09]

You may want to indicate to the client that this is part of your reflex testing to rule out any underlying alloantibody(s).

[Barbarakym]

I suggest dropping the solid phase from the name. We use gel which also gives too many non specific reactions. In the old days tube testing also have non specific reactions. Basically no specific antibody identified, clinically significant Ab ruled out). We call all those from all methods Non-Specific Antibody.

Have never had a complaint.

[adiescast]

I agree that changing the name will be the easiest solution. We call ours "Coombs reactive antibody of undetermined specificity". It is always difficult to come up with terminology that will provide appropriate information without causing difficulties itself. I think "Nonspecific antibody" is also a good description.