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mld123

Sunquest Billing - Irradiation

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Anyone using Sunquest have any information on how you have set-up charging for irradiated products that are not specifically ordered on a patient?  We have irradiated red cells that we will transfuse to patients that were not ordered for irradiation.  We would then need to manually credit the irradiated product and charge the non-irradiated product.  Can you give me insight into how you did this easily in Sunquest?

 

Thanks!!

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According to CMS, you cannot bill for the irradiation CPT code when an irradiated product P Code is available.  At least that is what I am being told by my billing people.  That is how I was originally going to set it up to charge the irradiated and cmv negative units at issue with the pop up box by charging the irradiation or cmv negative CPT code.

I may just use the pop up box anyway because the only other option is to credit every irradiated/cmv neg unit transfused that was not ordered for that patient and then manually bill for the correct product.  We keep irradiated products on hand for our oncology outpatient transfusions and if not needed we transfuse them to someone else.

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We currently do as you described - the techs add a credit irradiation charge if the patient doesn't need it, but then we have to go into the account and manually credit the irrad RBC and bill for the correct non-irradiated RBC instead.

You could set up a charge edit rule in Sunquest to do this automatically (I have been thinking about this as well).  Sunquest should be able to help you with charge edit rules if you've never done them before.  Basically you create a rule so that anytime Sunquest sees the credit irradiation code AND the irrad RBC charge together, then the resulting charge would be the regular LR RBC charge code instead.  We haven't set this up for crediting the irradiation, but we bill this way for some of our manipulations like aliquots so we can charge for the split P9011 product instead of a whole product.

You might even be able to do this without the charge edit rule.  Set up a new charge (we'll call it CRIR for credit irradiation).  In the billing maintenance for CRIR, define a CREDIT for the IRRAD RBC charge code and a CHARGE for the LR RBC.  The techs would still have to add the CRIR charge at the time of issue (when an irradiated RBC is issued to a pt who doesn't need irradiation), but it would adjust the charges automatically.

We have gotten pretty creative learning how to bill for manipulated/divided products at our pediatric transfusion service - feel free to send me a message:)

Stephanie

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Thanks Stephanie.  I am going to pass your information along to our LIS person. I love the idea of building the credit for irradiation which credits the irradidated RBC and then bills for the LR RBC.

 

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Our irradiation charge is built in the blood component code RAFI is Irradiated Red Cell which includes billing for the red cell plus irradiation plus our processing fee. When the product is issued all is billed. To fix the problem for units going to a patient that does not need irradiation we created two billing codes to back out the irradiated blood charges and re-bill the unit as a non-irradiated unit. CRAFI (credit RAFI) and BRAF (bill RAF). When the unit is issued these codes are used in the pop up charge window. So far it's working for us.

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