Charging for antigen typings

[BankerGirl]

How long ago was that?  It used to be that way, but the last billing talk I went to through the Red Cross stated that you could use probability to bill for the number of units screened.  So you wouldn't expect to screen 10 to get 2 K-negative units, but you might screen 10 to get 2 little c or Jka-negative units.  Is that the way everyone else understands it?

 

Actually, that was just a couple of months ago.  Not saying that she was correct, but we did change our billing practices as a result.  That's why I was hoping for an "expert" opinion.  As for Malcolm's comment about Jk(a-b-), we would request those units from our blood supplier and let them decide what to charge.

[Malcolm Needs ☆]

That was a somewhat tongue in cheek comment BankerGirl!

Edited March 5, 2015 by Malcolm Needs

[BankerGirl]

That was a somewhat tongue in cheek comment BankerGirl!

I did know that Malcolm.  And we appreciate that luxury of using our reference lab for our difficult to find units.  That being said, I did recently resort to transfusing an A Neg unit to an A Pos patient with an anti-C when, after screening 13 units, I only found one C negative A Pos unit.  Cheating, I know, but much faster and cheaper!

[tbostock]

I was told by our billing compliance folks that we can only charge for the number of units ordered regardless of how many we screen to find the required units.  I would also like a definitive answer, because we end up doing a lot of these for free.

It was changed a few years ago that you are now allowed to charge for the total number of units that you had to screen to obtain antigen negative units. I've never seen in any reimbursement documents that it's allowed to charge multiple patients for the same antigen typing though.

From the AABB website:

Billing for Antigen Testing

Question: Is the blood bank able to bill for antigen testing on all the units tested or for just the antigen negative units?

Answer: The CPT description for code 86903 Blood typing; antigen screening for compatible blood units using reagent serum, per unit screened instructs to bill for each unit screened. Therefore, the facility can bill for all units tested to find the antigen negative units. However, if a single unit is tested for multiple antigens, 86903 may be billed only once.

Reference

AMA 2007 CPT

[BankerGirl]

It was changed a few years ago that you are now allowed to charge for the total number of units that you had to screen to obtain antigen negative units. I've never seen in any reimbursement documents that it's allowed to charge multiple patients for the same antigen typing though.

From the AABB website:

Billing for Antigen Testing

Question: Is the blood bank able to bill for antigen testing on all the units tested or for just the antigen negative units?

Answer: The CPT description for code 86903 Blood typing; antigen screening for compatible blood units using reagent serum, per unit screened instructs to bill for each unit screened. Therefore, the facility can bill for all units tested to find the antigen negative units. However, if a single unit is tested for multiple antigens, 86903 may be billed only once.

Reference

AMA 2007 CPT

Our LIS coordinator has the current CPT (2015) code book so I decided to look it up.  Code 86903 no longer exists, and 86902 says "If multiple blood units are tested for the same antigen, 86902 should be reported once for each antigen for each unit tested."  My interpretation is that you can bill for all units tested AND for all antigens tested on each unit.  It doesn't say anything about what to do if the unit is already tested from another patient.  Maybe we will change back to the way we were charging.

[Mabel Adams]

I remember being told at ARC billing workshops that we can't charge twice for the same testing.  Also, the latest CPT code quoted above is what we do now that it is legal to do so--charge for all units tested, for all antigens tested, but only once.

[Dr. Pepper]

I was told by our billing compliance folks that we can only charge for the number of units ordered regardless of how many we screen to find the required units.  I would also like a definitive answer, because we end up doing a lot of these for free.

This was how it used to be, but they changed as of several years ago.

[Dr. Pepper]

We use the following formula to calculate how many units to screen (forgive me if everyone knows this bit of basic lab math, perhaps someone may find it useful):

# units to screen (x) = 1 / probability of finding the blood

Patient has anti E+K+S probability is 0.664 x 0.9 x 0.45 = 0.26

x = 1 / 0.26 = 3.8 units If you need multiple units, multiple x by the # you need. So for 5 units 3.8 x 5 = 19.

We start with this. If we screened 19 units to find 5, and 8 were negative for the antigens, we would still charge for all the typings peformed. If we only found 2, we would recalculate the odds for 3 more units and have at it again and bill more charges.

We keep a paper logsheet of our ag typings, which cannot be conveniently put into a worksheet in our LIS. We also record the specimen # we billed on. If ever audited, we can show exactly why we billed what we did.

[Mabel Adams]

We had to devise a way that we could prove what units we tested and charged the patient for in case an auditor ever asked.

[SRMC BB]

We charge both sets of patients.  We have our own Donor Center so we have a lot of repeat donors and some have a history of antigen typings. If we can pull from historical data, we use those, and charge for it, otherwise we screen to find antigen negative units and only charge for the units crossmatched.  If they aren't given, they are still charged for the crossmatch and antigen screening, just not the units and all the nursing administration fees.

[tricore]

From AABB Reimbursement and Coding Work Shop 10/2010

For 2011, the American Medical Association (AMA) has changed

the CPT code for antigen screening using reagent serum.

The following coding change will take effect on January 1, 2011:

As a result of this coding change, providers should bill for antigen

screening based on the number of antigen tests (rather than the number of

blood units screened) beginning in 2011.

CPT copyright 2010 American Medical Association. All Rights Reserved.

CPT Code 86903

Blood typing; antigen screening for

compatible blood units using

reagent serum, per unit screened

Valid for dates of service through

December 31, 2010

CPT code 86902

Blood typing; antigen testing of

donor blood using reagent serum,

each antigen test

Valid for dates of service on or after

January 1, 2011

[Karrieb61]

Oh boy, I am so confused. For what's it worth, we get some units already screened by our Blood Center for Kell, C, E, c, e and we don't  charge the patients if they need one of these. Kind of like they already were screened for the ABO and D antigens when we got them and we don't charge the patient for retyping the units from the Blood Center. We charge only the first patient we antigen typed the unit for, then tag it, and if not used, its a freebie for the next patient. We charge for each and every antigen on a single unit that we screen and that is the part that now worries me. If audited, do we get slapped?

We were billing for some misc charges using a defunct CPT code (gone since 2010 I found out) and our billing people never said a word which amazes me because these were screens that they had to look at each time. I only found out when I investigated an error a tech made while billing a patient recently. Now I have a headache

[tricore]

Hospital billing is so complicated it is a wonder it ever gets done correctly. Billing coders have to look at the regs every year because they keep changing. I am surprised that the billing with the wrong cpt code didn't get rejected, especially by Medicare.

[BankerGirl]

tricore:  Your reference is outdated.  I quoted the 2015 version which says each antigen for each unit. 

 

Karrieb61:  It seems to me that you are doing this correctly.

[mollyredone]

Karrieb61,

 

Is your blood center charging you for those antigen typings?  If so, you can charge any patient that needs antigen negative blood for those antigens.

 

We get a "historically negative" antigen database from our blood supplier, so we know which units to type, and it has really cut down on how many we have to screen, but we do have to screen them, and we do charge the first patient for whom they are screened.

[Eagle Eye]

Karrieb61,

 

Is your blood center charging you for those antigen typings?  If so, you can charge any patient that needs antigen negative blood for those antigens.

 

We get a "historically negative" antigen database from our blood supplier, so we know which units to type, and it has really cut down on how many we have to screen, but we do have to screen them, and we do charge the first patient for whom they are screened.

where are you? East cost? who is your supplier? Sorry asking too many questions...

[Mabel Adams]

Because Mollyredone gets historically negative units and her supplier is a competitor to my supplier, we now get some historically negative units for no charge.  It has really helped with our needing to order in screened units too.

[mollyredone]

Glad to hear it Mabel!

 

Eagle Eye, we are on the west coast (Oregon) and use a community blood bank that is awesome!

[Eagle Eye]

Ooops...one of my supplier started sending units screened for Rh and K.

I hope my second supplier does the same..

[goodchild]

I don't think there's a question about whether it's per antigen or per unit, or even if you have to test more than the patient is ordered for due to positives - we can all agree there's enough information out there that says that's completely fine.

 

The troublesome situation is when blood is typed/ordered antigen-negative from the blood supplier and then not used on that patient but subsequently used for a different patient.

 

The appropriate practice described by my "first line" billing compliance individual filled me with terror because it was so convoluted. I'm going to climb a bit higher up the chain and find out their perspective. Have others spoken with their billing compliance people (specifically ones who are familiar with lab/blood bank)?

[BloodBankGuy]

If you attend any Medicare billing conferences they discuss this in detail.  You can only charge for an antigen typing to one patient.  Now if you want to charge it to the patient you initially screened  OR the patient that is receiving it if the first didn't need it that is fine, but charging bothing for something you have done once is a mischarge.  At least that is how it is discribed.

[R1R2]

I agree with BBGuy

[kirkaw]

We have been charging both patients in the situation initially described and never had Medicare or any other insurance kick it back. There are lots of things we cannot charge for, so I don't see what is wrong with charging for something the patient NEEDS, even if it wasn't ordered for them originally. If anything in this scenario seems unethical, it's charging the 1st patient for the antigen typings on blood he/she did not receive. But I agree with the person that stated that this can be a nightmare, because that account might already be weeks old and closed out.

[Dr. Pepper]

We have been charging both patients in the situation initially described and never had Medicare or any other insurance kick it back. There are lots of things we cannot charge for, so I don't see what is wrong with charging for something the patient NEEDS, even if it wasn't ordered for them originally. If anything in this scenario seems unethical, it's charging the 1st patient for the antigen typings on blood he/she did not receive. But I agree with the person that stated that this can be a nightmare, because that account might already be weeks old and closed out.

I am guessing no one ever kicked it back because no one ever came down and looked at your records to see if that "second" test was actually performed or not.