Billing Blood Products
Billing Blood Products
Prior to the implementation of the Hospital Outpatient Prospective Payment System (HOPPS), blood products were typically billed with only a revenue code; a procedure code was not needed. Reimbursement from the Medicare Program reflected the charge factored by the ratio of cost to charge for the blood bank department. It was obvious that under a prospective payment system that procedural coding would be necessary to identify a product for accurate and effective reimbursement. It was also obvious that only two projected APCs (Ambulatory Payment Classifications) or categories for blood product reimbursement would lead to an inefficient and deficient identification of blood products.
Two categories of revenue codes exist for identifying blood products (Table 1). Traditionally, the 38X series of revenue codes indicated a purchase of the actual blood or blood product. Medicare billing edits would allow blood products to be billed with this revenue code series and Level II “P” codes for the appropriate product. But, since the blood is not usually purchased by most hospitals, this revenue series appears inappropriate and not typically recognized by Medicare. Most hospital blood banks are billing for the processing costs surrounding the collection, preparation and conveyance of blood. These processing and related storage costs are reflected by the 39X series of revenue codes. Previous Medicare edits have not allowed these revenue codes to be reported with Level II blood product codes.
When APCs were required for payment last August 1, Medicare had not accommodated edit changes to allow product codes to be billed with the 39X revenues codes. The result included denials of claims or inappropriate reimbursement. Resolutions were required.
Resolution No. 1
The first resolution was for Medicare to address the product codes and correlating APCs. New “C” codes were created and placed on the list of additional pass-through services for which Medicare would allow additional payment. The 2001 HCPCS book also added new “P” codes to further identify blood products. These codes also required a greater variety of APCs reflecting more realistic reimbursement. “C” and “P” codes are linked to status indicator “K” to indicate a drug or biological not eligible for pass-through payment, but rather paid under an APC.
Resolution No. 2
The second resolution was for Medicare to address the issue of relating revenue codes to product codes. On Dec. 11, 2000, HCFA (Health Care Financing Administration) provided guidance through the FAQs section on its Web site to bill the products with the appropriate product code and revenue code from the 38X category. New guidance from HCFA was provided this year on Jan. 20 and indicated that edits had been changed to allow the product codes to accompany revenue code 390. The latest advice is to bill the appropriate blood product code (“C” or “P”), when only processing is being billed, with revenue code 390. Indicate the number of units provided; thus, the APC amount multiplied by the number of indicated units equals reimbursement. The few clients and seminar participants I have queried are indicating business office reports of payment.
1. If blood is actually purchased, do not bill processing in addition to the HCPCS code, as the processing is included with the HCPCS code.
2. Other laboratory services (typing, crossmatch) may be separately coded.
3. A new edit requires the blood product to be billed when administration (transfusion) is billed.
4. One unit of administration, CPT 36430–36460, may be billed once per day along with revenue code 391.
The blood deductible only applies to whole blood or packed RBCs (first three units). The deductible is not applied unless blood is actually purchased; this is indicated by value codes on the claim:
I hope you are all now receiving appropriate payment for these services.
Diana Vorhees is principal in DV & Associates Inc., Salt Lake City, which makes no representation, guarantee or warranty, expressed or implied, that the information provided is free of error, and will bear no responsibility or liability for results or consequences of its use.
TABLE 1: Revenue Codes
380 General classification
381 Packed red cells
382 Whole blood
386 Other components
387 Other derivatives (cryoprecipitate)
389 Other blood
39X Blood Storage & Processing
390 General classification
391 Blood administration
399 Other blood storage & processing