Oncology & Hematology Coding Alert

Missing out on separately reportable drug reimbursement could have you seeing red

Blood transfusions are par for the course when treating cancer patients, but knowing which codes to report and who may report them can be tricky. Don't let your payer stick it to you - we've got the lowdown on how to go with the flow on your next transfusion claim, including when to ask your patient to sign an Advance Beneficiary Notice (ABN).

Be on the watch: Oncologists are most likely to order a blood transfusion for a patient experiencing anemia due to chemotherapy, says Garnet Dunston, CPC, MPC, past secretary-treasurer of the American Academy of Professional Coders. Leukemia patients may need transfusions before and after chemo, and if your oncologist is also a hematologist, you may see reports for hemophilia or other coagulation defects, she adds. Investigate 'Incident-To' Rules In the office setting, nonphysician employees, such as registered nurses, oncology certified nurses, or other nursing staff, perform most blood transfusions.

Red flag: This means the employee needs to perform the blood transfusion under "incident-to" rules - before you code, be sure you have documentation that a practice physician was in the office suite and immediately available during the procedure. Perform Separate Counts for Service and Supply For a blood product, each pint equals one unit. Careful: Regardless of how many blood product units you use and report, only report 36430 (Transfusion, blood or blood components) one time.

Example: Your patient requires three units of packed red blood cells and three units of fresh frozen plasma. Your freestanding center supplies both the service and the blood products. Report one unit of 36430, three units of P9021 (Red blood cells, each unit), and three units of P9017 (Fresh frozen plasma [single donor], frozen within 8 hours of collection, each unit).

Remember: Carriers often won't pay unless you code for both the transfusion and the blood product. If you're a freestanding center that performs a transfusion, but the hospital supplies the blood, be sure to get an ABN in which the patient agrees to cover any charges Medicare won't. The ABN states that you suspect Medicare won't pay for the service and the patient must choose whether he is willing to receive the service knowing he may have to pay.

You should also include an estimate of the cost, have the patient sign and date the document, and give the patient a copy for his records. Watch for: Some private insurers accept "waivers of liability" similar to the ABN, so find out if your patient's insurance offers this reimbursement safeguard. Inject Extra Reimbursement Into Your Claim When you send in a claim for blood transfusion code 36430, your payer will typically include reimbursement for [...]