I am little regarding charges for all the technique. How do you bill for special technique you performed to identify antibody? eg. If you perform initial panel and identify anti-c and bill the patient for ABID. Now you need to perform enzyme because you suspecting other antibody.....you identify only anti-c again but no additional antibody. WHen we do enzyme we need to run the panel. Do we need to bill the patient again for panel or the charges associated with enzyme(or absorbtion or elution) includes the cost of panel???

Thank you in advance

The CPT codes for billing antibody ID specifically state that they can be charged for each method used.

We bill for ABID for each specific methodology used. Even if the additional testing did not lead you to an additional antibody, you still performed the testing and should be able to charge accordingly.

Does anyone have a cost analysis of antibody ID, reagent cost, time cost and amount of refrigerator space, necessary equipment, cell washer, limited ID and full service, etc

We are looking into doing our own AB ids, currently we send them out to another hospital which increases our TAT

Every once in a while, someone presents a poster at the annual meeting about this topic. Their recommendation: do some of it yourself. Biggest decision-maker is whether you use gel for screens; no cell washer is needed if you do, and we rarely use our old one anymore.

When I took over my current position, they were sending all positive screens out -- long TAT! At ~$600 per workup, it was a no-brainer that identifying just one antibody ourselves would pay for doing workups in-house. It doesn't take much refrig space for a panel and a few common antisera, and the extra gel cards are stored at RT. The one PT survey is not that expensive. Our techs were quite trainable, and most had experience elsewhere.

The big decision I had was how much to do. Sure, we could do alot, but that means more panels, more expensive antisera, a bigger PT survey, and definitely more training. There were 2-3 new SOPs added to the manual.

I started by studying the patient population, finding mostly Anti-D, Anti-K, Anti-E, Anti-c and an occasional Anti-Jka dominated our history files (>95%). Pos DATs were almost always warm-auto's reactive with everything, so eluates were out of our league. We have never had a sickle cell patient. Although we do few deliveries, we do Fetal Screens in-house also.

So, stocking one panel and the above antisera (without the Anti-c) decreased our TAT on 95% of pos screens to <2 hrs and saved about $50K this year -- no cost analysis needed! Anthing not identifiable with the one panel is sent out, as are eluates. We order Ag-neg units for Anti-c and historical Ab's that are no longer reacting with screen cells. And our techs like the extra intellectual stimulation at our small rural facility.

No complaints from the CFO or the medical staff either ...

For small facilities that have only one busy tech on-site, you have to make sure that they have the time to perform a panel (or have an on-call person available to help).

thank you, this really fits and expands our situation, we want to avoid

time consuming elutions and other techniques that are best done by

dedicated blood bankers.

we rotate a number of techs thru our blood bank, it would seem difficult

for all of them to acquire the experience to perform the difficult AB-ID's.

and space was another concern.

Is it necessary to do both IG and poly DAT's for panels,

and is it best to do the panels on the automated analyzer for BB by gel

or use manual gel [should save reagent, I understand the prime uses a lot of

reagent]

LK

"Necessary" is one of those interesting words in blood banking. It isn't necessary (read: required) to do alot of the things we do, but I can't sleep at night unless we do them ...

We run an auto control on full panels (not r-sets for passive Anti-D) and run a DAT only if the auto ctl is positive. We report Anti-IgG and Anti-C3 when doing DATs, and leave it up to the clinician if an eluate is warranted (except post trn rxn).

We decided against automation years ago, since our volume is so low. We run manual gel for screens and panels, and tube testing for everything else. But if you already have the automation available, you might as well use it, since it's more consistent.

If you are a larger site and have a patient population to support it, you could have 1-2 people on the day shift with expertise to do eluates, more extensive ABID's, etc. A second- or third-shifter could leave the routine tough ones for you, and you could decide how much you want to play with it before forwarding it to a reference lab. Cost becomes a big factor here, since reagent antisera is very expensive, as is more PT Surveys, training, SOPs, etc.

I am little regarding charges for all the technique. How do you bill for special technique you performed to identify antibody? eg. If you perform initial panel and identify anti-c and bill the patient for ABID. Now you need to perform enzyme because you suspecting other antibody.....you identify only anti-c again but no additional antibody. WHen we do enzyme we need to run the panel. Do we need to bill the patient again for panel or the charges associated with enzyme(or absorbtion or elution) includes the cost of panel???

Thank you in advance

In addition to charging for another panel, you can charge for treatment of the panel cells. So an enzyme panel can have a charge for treating each cell, plus a charge for testing each cell against the patient's plasma. Additionally if you do something to the plasma like an adsorption, you can charge for that, then charge for the testing done with the adsorbed plasma.

Here are the codes:

86870 Panel

86885 Each additional panel cell

86970 Treatment of RBC for testing (enzyme, DTT, chloroquine, EGA)

86975 DTT treatment of plasma

86977 Neutralization

86978 Adsorption

I realize this is a very old post, but I am wondering about billing for DTT-treatment. Say we treat our 3-cell screen with DTT then perform a screen...I would charge for the additional screen run with the treated cells and CPT 86970. But do I only charge 86970 once, or 3x--once for each screening cell?