Can anyone tell me how you bill patients for sickle cell testing you perform on donor units for transfusion? An auditor is telling us that we can not charge an outpatient for sickle cell testing on donor units....we can only charge sickle cell testing that is performed on the patient.

This was news to me.

I think your auditor may be correct. We do not bill patients for sickle cell tesing on units. I did a stint as a Chargemaster Coordinator for about a year and I think the billing people would say that the sickle cell testing is "part of the procedure" in getting the units ready for the pt.

Maybe you could set up a $0.0 charge to at least get the workload credit for doing the test.

We get charged by our blood supplier for the Hgb-S testing so we pass it along just like we do for the antigen typing they do for us.

Why would that be any different? Once again you are dealing with one person's opinion, if you do a lot of this testing you might want to seek another, possibly more qualified, opinion before giving up on it.

So, John, how do you "pass it along"? Do you increase the price of a unit of red cells to cover the sickle cell testing?

If you don't mind sharing, how are you charging for your supplier antigen typings?

I copied this from the AABB website. I hope it helps.

Billing for Blood and Transfusion Services: Frequently Asked Questions and Answers

Question: Can you charge for Sickle Cell testing on units for Sickle Cell patients and if you are protecting a patient from other antigens, which may stimulate them to produce even more antibodies, can you charge antigen typings for those units? For example a sickle positive patient who needs products which are sickle negative and E negative due to the patient having Anti-E but we also give K and S negative in order to protect patient in accordance with their phenotype.

Answer: Yes, you may bill for any service performed on a blood component for a patient if it is medically reasonable and necessary. The sickle cell patient protocol is now standard practice to start all new patients (and older patients that are antibody formers) with C, E, K neg (some facilities also do Fya as appropriate). This should be stated in your Transfusion Services policy (SOP) on Hb SX patients. In these cases, you would code CPT 85660 per unit screened and 86905 per antigen/per unit typed. Revenue code is 030X for both.

Reference: AMA 2007 CPT

Thanks KLCarter, I could not have said it better myself.

AABB is a good source for billing help. The next best place is your Medicare intermediary. Intermediaries do differ in what they reimburse. That little-known fact makes most reimbursement advice given on this site of dubious value unless both the asker and the askee are under the same intermediary. Just because there is a CPT code for a procedure doesn't mean your intermediary will pay for the procedure.

BC