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Thread: Blood Transfusions

  1. #1
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    Default Blood Transfusions

    Hello,

    Regarding CPT 36430 - if 2 units of blood is given, can this code be billed with 2 units.

    Any help is appreciated.
    Thank you,
    Kristen
    Kristen Richard, CPC

  2. #2
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    Per CPT Assistant (March 2001) you should only report one time, per transfusion, regardless of how many units are administered.

  3. #3
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    Thank you,

    I did find the article, but is that still effective and has not had any changes? Because we have always billed this code with units, and it has never been questioned. Now we are being questioned. Doesn't make sense, all of a sudden. Do you know of any recent articles for this.

    Thanks,
    Kristen Richard, CPC

  4. #4
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    CMS' MUE edits show 1 per day

    36430= 1


    http://www.cms.gov/NationalCorrectCo....asp#TopOfPage

  5. #5
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    Yes, it does show a 1 in the column, but is there any article or documentation that I can obtain that says only one unit can be billed, other than the article from 2001.

    Thanks again,
    Kristen Richard, CPC

  6. #6
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    Sure...this is actually a RAC issue

    2009 article:

    Connolly Healthcare, the RAC for Region C, lists blood transfusions as one of its initial “Approved Issues.” Their description of the issue begins “CPT codes 36430, 36440, 36450 and 36444 (excluding claims with any modifiers) should be billed as one (1) per session.”

    http://www.healthcarefinancenews.com...hcpcscpt-codes

    -OIG-2010

    CMS’s Manual, chapter 4, section 231.8, states that providers should bill for blood transfusion services (HCPCS code 36430) on a per service basis. Medicare will pay the provider for transfusing blood products once per day, regardless of the number or volume of different blood products transfused.

    http://oig.hhs.gov/oas/reports/region3/31010004.pdf


    Journal of Health Care Compliance (2004)

    CPT Assistant, March 2001, page 10 indicates: “From a CPT coding perspective, code 36430, Transfusion, blood or blood components, should be reported only one time per transfusion, regardless of how many units
    are administered.” Given the large number of transfusion services provided on an outpatient basis throughout the country, the financial impact of misreporting these services can be considerable.

    http://www.ingenix.com/content/attac...04_Stegman.pdf
    Last edited by RebeccaWoodward*; 07-22-2010 at 12:21 PM.

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    Thank you very much, that is very helpful.
    Kristen Richard, CPC

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    Thumbs up

    Happy to help!

  9. #9

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    The facility i work at I code out the hospital charges, am i allowed to bill code 36430???? One of my phycisians did it but how do i bill for the charges?

    Thanks in Advance,
    Chancie S Kreger, CPC-A

  10. #10
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    Yes you may. We also bill it as a facility charge. But you can only bill 1 unit as I have learned.
    Kristen Richard, CPC

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