Add on units on current Type and Screen

[frenchie]

Question:

How do you proceed when a provider is adding units on a specimen from a different date (<3 days) in your LIS (I use Meditech)?

I am a little confused about this issue, some techs at our lab add on units to the original specimen, others redo a TS and crossmatch on new order... specially if it is a different provider who ordered the crossmatch vs TS.

And is there any CMS or other billing reg about this situation?

Thank you all in advance for your help!

Helen

[Teristella]

We use Meditech and the units are automatically added to the most recent, current blood bank specimen. In this case it would be a current type and screen.

We do not repeat type and screens if it is a new provider, as the provider is recorded in Meditech.

[SMILLER]

27 minutes ago, frenchie said:

 

I am a little confused about this issue, some techs at our lab add on units to the original specimen, others redo a TS and crossmatch on new order... specially if it is a different provider who ordered the crossmatch vs TS.

And is there any CMS or other billing reg about this situation?

Helen

Not sure about regs for this particular situation, but I really don't think you should have different techs taking different approaches to such a key area as to which specimen to use for crossmatching.  Surely you have a written P&P that someone is not following?  I would think that tha,t by itself, would result in a citation from an inspector were they aware of the situation.

Scott

[Dr. Pepper]

I'm interpreting the <3 days to mean your specimen is still within the usability window but a day or two down the road from the original type and screen. We have never had a billing issue with inpatients, I think mainly because they're DRGs and no one pays on a per item basis anyway. I think the biggest issue might be getting the charges for the blood posted on the correct patient account. If your specimen was from, say, an outpatient preop PAT and then they get admitted (could be > 3 days), or an outpatient draw for an outpatient transfusion the next day, the blood charges unfortunately will follow the original specimen and get posted on the wrong day of service and the wrong patient account. We used to do the crossmatches on paper ahead of time in these situations, then put them in the LIS on the day of service  when the new account was created, a awkward system just asking for a secretarial error to happen. Now we can do them on the original type and screen and Fiscal happily (I guess, it was their idea) transfers the charges to the proper account behind the scenes.

Keep in mind you don't have to tack the units/crossmatches onto a type and screen; they can be ordered on another specimen just by themselves. We create a new specimen on the desired account and date and order the units, along with a nonreportable informational test "SPEC USED" so we can record the old specimen we actually used for the crossmatches. Our Meditech trainer told most customers do it like that.

I would not want to do another type and screen if there was a valid specimen that was still within your time limits. Extra work, expense, and a stick to the patient.

I also agree with Scott - get everyone on the same page with a system that works for you and your fiscal dept. Trust me, the third party payers will let them know if something is amiss with your blood charges.

[frenchie]

37 minutes ago, Teristella said:

We use Meditech and the units are automatically added to the most recent, current blood bank specimen. In this case it would be a current type and screen.

We do not repeat type and screens if it is a new provider, as the provider is recorded in Meditech.

Teristella, this sounds great, do you know where Meditech is set up for that parameter?

[Teristella]

Unfortunately I don't have dictionary access in our system. I've done a bit of work helping my supervisor but we were never really trained and figure a lot of things out by trial and error. I'd ask Dansket or goodchild perhaps, if you can't find it by poking around in TEST.

I'd imagine this is a Product Group parameter, because Meditech should add the XM to whatever req it places the products on. If you wanted other orderable tests your providers use to also tack on to the most recent req, you'd have to change those individual test parameters too.

There may also be a parameter in your type and screen profile limiting Meditech from adding tests to the specimen, so you might have to check there.

[Dansket]

Frenchie,

Is there an Order/Entry interface between your HIS and the Meditech BBK module or are all BBK tests manually ordered in Meditech?

 

[goodchild]

We have Meditech 5.67 C/S. Providers don't get to add crossmatches onto specimens. It's not orderable for them.

They have a Request for RBCs order in our CPOE that has queries for all of the info we need (i.e. # units, indication for transfusion, reminder about informed consent, who the authorizing attending physician is, and checkboxes for special transfusion requests). This translates to lab as a specimen and the details are specimen comments.

It's the technologist's responsibility to review the patient's history/current testing and choose an in-date specimen for crossmatching. We add crossmatches to the Type and Screen requisition. There's occasionally some confusion with this model but we're still able to easily identify who ordered what.

[labguru]

We have Meditech also, and once the doctor orders additional product, Meditech will attach it to a viable sample if there is one through a Daemon.  If the current sample is due to expire shortly, it will order a new TS and XM which will need to be collected.

[Dansket]

3 hours ago, goodchild said:

It's the technologist's responsibility to review the patient's history/current testing and choose an in-date specimen for crossmatching.

Does this mean that a physical specimen is retrieved from storage?

[Teristella]

Our techs would go insane if they had to manually add crossmatches to the correct requisition. Seems like a lot of extra work with the way we do things here.

[goodchild]

Only for antibody patients. I'm honestly confused how you handle a provider entering add on crossmatches.

[Teristella]

They don't. Clinical staff enter orders for products, not associated testing; Meditech adds the product to the newest BB specimen that is not expired (if it's going to expire in a matter of an hour or so, I believe it always generates a new one).

Crossmatches are reflexed testing.

[frenchie]

On Tuesday, March 01, 2016 at 1:04 PM, Dansket said:

Frenchie,

Is there an Order/Entry interface between your HIS and the Meditech BBK module or are all BBK tests manually ordered in Meditech?

 

Yes, there is an interface between BB module and HIS (which is also a Meditech product).