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Kathy

Apparently blood bankers did not build HCPCS codes...HLA matched plts

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Our billing guru told me that we can't bill for leukoreduced, irradiated, platelet pheresis + HLA coordination fee.  Apparently there is no HLA coordination fee billing code.  Is this correct? If there is no code and the product is ordered but not used, is there no way to get reimbursed for that enormous fee that we are charged by our supplier? 

 

I am a bit dismayed that there is a HCPCS for leukoreduced HLA matched platelets, but not for the same irradiated product.  By virtue of it being HLA matched, it must be irradiated.  So we would have to bill for the irradiation separately.  And then it becomes very complicated because when you scan in the platelet pheresis unit that is irradiated, HLA matched, the E code is for irradiated, leukoreduced platelet pheresis.  We will have to credit the HCPCS code associated with that product and manually bill the HLA product + Irradiation.  What a mess!

 

And while I am on my tirade, why is there no HCPCS code for Irradiated Granulocytes?  Seems to me that by virtue of your patient needing granulocytes, they are at risk for graft-vs-host disease and therefore need irradiated granulocytes.

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Talk to your government representative(s).  That's where the HCPCS codes, associated attributes and reimbursement rates are determined.  Talk about a flawed system--reimbursement rates are based on what has previously been billed, but available HCPCS billing codes do not cover actual scenarios/product attributes so system flaws are perpetuated!

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We include the cost of leukoreduction (we are 100% LR) in our processing/storage fee for the product. We pass a charge for irradiation or CMV Neg, but only if the physician orders it that way and it is required for that patient. For HLA matched products, the cost of that is included in the processing/storage fee for that product as well.

Yeah, they sure don't make it easy...

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I agree, so frustrating!  There is no HLA,irrad/LR plt pheresis code, so we bill for P9052 and add the irradiation charge separately (801108)... and this does mean that if the unit isn't transfused, you can't bill the extra fee for the HLA charge from the supplier.

 

We do the same with granulocytes; bill P9050 for the product and 801108 separately.

 

Stephanie Townsend, MT(ASCP)SBB

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so we bill for P9052 and add the irradiation charge separately (801108)

 

Sorry, I need to correct myself, the code for irradiation is 86945 :)

Stephanie Townsend, MT(ASCP)SBB

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