Wiki 36430 multiple transfusions 1 encounter multiple dos

[amyce2693]

Hello!
If a patient is seen in the ED or OBS department over multiple days and given a blood transfusion 12/01 10:30pm and then requires another one after midnight 12/03 03:30am is this billed twice on 2 different dos? I am understanding the MUE as 1 per encounter/claim no matter how many times this is performed. Others believe it is "once per day" but this was also not 24hrs apart, so technically this isn't once per day.
Thanks! Please attach any links supporting a response.

 

[thomas7331]

At the facility where I coded this situation numerous times over several years, we always coded by the date of the service, not by encounter, so we'd code a new initial service after each midnight. I know that occasionally a payer would give us a rejection for multiple initial services in the same encounter, but in the vast majority of cases there was no issue with this.

 

[amyce2693]

At the facility where I coded this situation numerous times over several years, we always coded by the date of the service, not by encounter, so we'd code a new initial service after each midnight. I know that occasionally a payer would give us a rejection for multiple initial services in the same encounter, but in the vast majority of cases there was no issue with this.

thank you! facilities all seem to interpret it differently. one facility says it has to be 24hrs apart from the initial order with a new order, which i somewhat agree with, but some think it can be billed no matter what even if it's part of the same order started the night before and then another with no new order given after midnight so it seems no one really knows. to me, i interpret the MUE as 1 per claim but the MAI is a 3 if medical necessity is provided. i would like to know what is being paid and what's not. i'm a contract coder so we don't get to see payment/EOB's unless they come back and tell us which i haven't been able to see lately.