Billing for Antigen typing

[Eagle Eye]

How do you charge the patient for screening donor units for antigen?

How do you charge if patient has multiple antibody and you need to screen more units to get required units?

[tricore]

As of Jan 2011

cpt code 86902 antigen testing of donor blood using reagent serum, each antigen test

If multiple blood units are tested for the same antigen, 86902 should be reported once for each antigen for each unit tested

[Eagle Eye]

SO LET'S SAY IF I SCREEN 20 units for c, then four of them I screen for E, then 3 of them I screen for K.

Patient needs c-,E-,K- units.....How many time 86902 i can bill?  

[goodchild]

86902 x27

[tbostock]

Yes, what goodchild says.  My only exception is when a tech needs one K neg unit and screens 20.  Ugh...I don't charge the patient 20 when the tech should have known to just screen one or two units.

[goodchild]

A follow up question for this thread may be, how does your particular institution actually process these charges to the patient account? How is the workflow handled? How is the documentation handled? How does it capture in-house testing vs blood supplier testing?

[tricore]

p.s. if you have already charged antigen typing of a unit to a patient, you cannot bill the antigen typing for the same antigen on the same unit to the next patient who needs an antigen typed unit.

Example: type two units for K, all neg, bill first patient, first patient does not use them. Next patient needs K neg, have 2 units already typed, cannot bill the second patient.

[Dr. Pepper]

Yes to what everyone has said.

We calculate the number of units you would need to screen, with average luck, and start with that. If we have bad luck and don't find enough, we recalculate and look some more. If we find extra units, we celebrate our good luck and buy a Powerball ticket on the way home.

Our LIS doesn't really have a convenient way of making a digital worksheet, so we have a paper worksheet to record our results, and to copy from to enter results on the units in the LIS. We order the appropriate # of bill-only tests (as in Goodchild's x 27 example). We also record on the worksheet the spec # we billed on. If we were ever audited we could easily demonstrate why we were billing the 27 CPT codes.

It's also an easy mechanism to review the results and to catch the wastrel who does the 20 K typings to find the one unit, or types for c and E simultaneously and finds a half dozen E(-) units that we can't use because they're c(+).........

Besides telling the LIS, we put stickers on the units indicating the typing results, and that the typings have been billed out.

[mollyredone]

We are lucky because our blood supplier sends us a historical antigen database with each shipment.  Of course not all units are on there, but I can quickly sequester Jka- units with a tag that says historically negative.  I print out the database each week, separating units by antigen, so you can look down the list for the right type and antigen and then check to see if it is negative for any additional ones you might need. Our supplier will also send us historically negative units if we ask for them for no extra charge.  We have to type them in house and tag and charge for them.  We also put a copy of the antigen typing worksheet in the patient's antibody folder.

[Eagle Eye]

Where are you located? I wish our supplier does the same!!

[mollyredone]

I'm in Oregon.  We use a local blood bank in Eugene, but they have just affiliated with Bloodworks NW in Seattle.  I think Mabel was saying that Red Cross was now doing something like that as well.  In turn, if we have to antigen type a bunch of units we will fax our typing worksheet to Eugene so they have more historical data to input!  

I just found out that our blood supplier is sending units to Puerto Rico due to the Zika virus.

[Dr. Pepper]

Mollyredone, you are lucky indeed. And they trust you enough to input the data that you have found yourself! Our two local suppliers will gladly furnish you antigen-negative units - for a price, despite that they are undoubtedly going through a computer search of historical typings.

[mollyredone]

Dr. Pepper, we have had to order antigen negative units on a nightmare patient-16 recently-with anti-S, anti-K and anti-C.  Her phenotyping says she is negative for Fyb, so we are throwing that one in as well.  She also has an HTLA antibody, so half the units we were getting were incompatible by gel.  I discussed the situation with the reference lab and we decided to do a full crossmatch in tube instead of gel, since our compatible rate was only 50% in gel!

[Eagle Eye]

All our sickle patient we are trying to get DNA typing done so .... many time we do not need to order Fy(a-b-) units if patient is showing GATA mutation. That case we only honor Fya ....