Part B Insider (Multispecialty) Coding Alert

Published on Tue Mar 28, 2006 PDF

Helpful hint:  Include both transfusion and blood product codes on your claim

Coding for blood transfusions isn't simple, but you can come out on top if you know to report 36430 just once. Here's more on why you must do so--and why you may have to add an advanced beneficiary notice (ABN) to the mix.

For a blood product, each pint equals one unit. 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).

Heads up: 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.

When you send in a claim for blood transfusion code 36430, your payor will typically include reimbursement for preparation and supplies (except blood products) with the 36430 payment. Good coding practice dictates that you code for any supplies used; you shouldn't just accept separate reimbursement.

Show proof: Many Medicare carriers and private payors will cover drugs administered just before, during or immediately after the transfusion if you can show medical necessity.
 
For example, you can report drugs given to prevent reaction such as Benadryl or Solu-Medrol, says Laura Hovey, CPC, reimbursement manager at Cancer and Hematology Centers of Western Michigan in Grand Rapids. Report Benadryl with J1200 (Injection, diphenhydramine HCL, up to 50 mg) and Solu-Medrol with HCPCS J2920 (Injection, methylprednisolone sodium succinate, up to 40 mg) or J2930 (...up to 125 mg).