Billing for Autologous Blood (Including Salvaged Blood) and Directed Donor Blood
In general, when autologous (predeposited or obtained through intra- or postoperative salvage) or directed-donor transfusion is performed, OPPS providers should bill for the transfusion service and the number of units of the appropriate HCPCS code that describes the blood product. Payment for the product is intended to cover the costs associated with providing the autologous or directed donor blood product service (e.g., collection, processing, transportation, and storage). OPPS providers should bill the transfusion service and the blood product HCPCS code on the date that the transfusion took place and not on the date when the autologous blood was collected.
When an autologous blood product is collected but not transfused, OPPS providers should bill Procedure 86890 (autologous blood or component, collection, processing, and storage; predeposited) or 86891(autologous blood or component, collection, processing, and storage; intra- or postoperative salvage) and the number of units collected but not transfused. Procedure 86890 and 86891 are intended to provide payment for the additional resources needed to provide these services, which are not captured when a blood product HCPCS code is not billed. Because billing 86890 or 86891 is only indicated when autologous blood is collected but not transfused, the OPPS provider should bill 86890 or 86891 on the date when the OPPS provider is certain the blood will not be transfused (i.e., date of a procedure or date of outpatient discharge), rather than on the date of the product’s collection or receipt from the supplier.
When a directed donor blood product is collected but not transfused to the initial targeted recipient or to any other patient, refer to the section 231.7 titled “Billing for Unused Blood.”
Billing for Split Unit of Blood
HCPCS code P9011 was created to identify situations where one unit of blood or a blood product is split and some portion of the unit is transfused to one patient and the other portions are transfused to other patients or to the same patient at other times. When a patient receives a transfusion of a split unit of blood or blood product, OPPS providers should bill P9011 for the blood product transfused, as well as Procedure 86985 (Splitting, blood products) for each splitting procedure performed to prepare the blood product for a specific patient.
Providers should bill split units of packed red cells and whole blood using Revenue Code 389 (Other blood), and should not use Revenue Codes 381 (Packed red cells) or 382 (Whole blood). Providers should bill split units of other blood products using the applicable revenue codes for the blood product type, such as 383 (Plasma) or 384 (Platelets), rather than 389. Reporting revenue codes according to these specifications will ensure the Medicare beneficiary's blood deductible is applied correctly.
EXAMPLE: OPPS provider splits off a 100cc aliquot from a 250 cc unit of leukocyte-reduced red blood cells for a transfusion to Patient X. The hospital then splits off an 80cc aliquot of the remaining unit for a transfusion to Patient Y. At a later time, the remaining 70cc from the unit is transfused to Patient Z.
In billing for the services for Patient X and Patient Y, the OPPS provider should report the charges by billing P9011 and 86985 in addition to the Procedure code for the transfusion service, because a specific splitting service was required to prepare a split unit for transfusion to each of those patients. However, the OPPS provider should report only P9011 and the Procedure code for the transfusion service for Patient Z because no additional splitting was necessary to prepare the split unit for transfusion to Patient Z. The OPPS provider should bill Revenue Code 0389 for each split unit of the leukocyte-reduced red blood cells that was transfused.
Billing for Irradiation of Blood Products
In situations where a beneficiary receives a medically reasonable and necessary transfusion of an irradiated blood product, an OPPS provider may bill the specific HCPCS code which describes the irradiated product, if a specific code exists, in addition to the Procedure code for the transfusion. If a specific HCPCS code for the irradiated blood product does not exist, then the OPPS provider should bill the appropriate HCPCS code for the blood product, along with Procedure code 86945 (irradiation of blood product, each unit).
EXAMPLE: If an OPPS provider transfuses the product described by P9040 (red blood cells, leukocytes reduced, irradiated, each unit), it would not be appropriate to bill an additional Procedure code for irradiation of the blood product since charges for irradiation should be included in the charge for P9040.
Billing for Frozen and Thawed Blood and Blood Products
In situations where a beneficiary receives a transfusion of frozen blood or a blood product which has been frozen and thawed for the patient prior to the transfusion, an OPPS provider may bill the specific HCPCS code which describes the frozen and thawed product, if a specific code exists, in addition to the Procedure code for the transfusion.. If a specific HCPCS code for the frozen and thawed blood or blood product does not exist, then the OPPS provider should bill the appropriate HCPCS code for the blood product, along with Procedure codes for freezing and/or thawing services that are not reflected in the blood product HCPCS code.
EXAMPLE: If an OPPS provider transfuses the product described by P9057 (red blood cells, frozen/deglycerolized/washed, leukocytes reduced, irradiated, each unit), it would not be appropriate to bill additional Procedure codes for freezing and/or thawing since charges for freezing and thawing should be included in the charge for P9057.
If a blood product has been frozen and/or thawed in preparation for a transfusion, but the patient does not receive the transfusion of the blood product, the OPPS provider may bill the patient for the Procedure code that describes the freezing and/or thawing services specifically provided for the patient. Similar to billing for autologous blood collection when blood is not transfused, the OPPS provider should bill the freezing and/or thawing services on the date when the OPPS provider is certain the blood product will not be transfused (e.g., date of a procedure or date of outpatient discharge), rather than on the date of the freezing and/or thawing services.
The following chart of blood and blood products indicates whether providers should bill separately for freezing and thawing using the available Procedure codes.
HCPCS/Procedure Short Descriptor Billing of Freezing/Thawing
P9010
Whole blood for transfusion
Freezing and thawing are separately billable
P9011
Blood split unit
Freezing and thawing are separately billable
P9012
Cryoprecipitate each unit
Freezing and thawing codes not separately billable
P9016
RBC leukocytes reduced
Alternative P-code for frozen/thawed product available
P9017
Plasma 1 donor frz w/in 8 hr
Freezing and thawing codes not separately billable
P9019
Platelets, each unit
Freezing and thawing are separately billable
P9020
Plaelet rich plasma unit
Freezing and thawing are separately billable
P9021
Red blood cells unit
Alternative P-code for frozen/thawed product available
P9022
Washed red blood cells unit
Freezing and thawing are separately billable
P9023
Frozen plasma, pooled, sd
Freezing and thawing codes not separately billable
P9031
Platelets leukocytes reduced
Freezing and thawing are separately billable
P9032
Platelets, irradiated
Freezing and thawing are separately billable
P9033
Platelets leukoreduced irrad
Freezing and thawing are separately billable
P9034
Platelets, pheresis
Freezing and thawing are separately billable
P9035
Platelet pheres leukoreduced
Freezing and thawing are separately billable
P9036
Platelet pheresis irradiated
Freezing and thawing are separately billable
P9037
Plate pheres leukoredu irrad
Freezing and thawing are separately billable
P9038
RBC irradiated
Freezing and thawing are separately billable
P9039
RBC deglycerolized
Freezing and thawing codes not separately billable
P9040
RBC leukoreduced irradiated
Alternative P-code for frozen/thawed product available
P9043
Plasma protein fract,5%,50ml
Concept not applicable
P9044
Cryoprecipitate reduced plasma
Freezing and thawing codes not separately billable
P9048
Plasmaprotein fract,5%,250ml
Concept not applicable
P9050
Granulocytes, pheresis unit
Concept not applicable
P9051
Blood, l/r, cmv-neg
Freezing and thawing are separately billable
P9052
Platelets, hla-m, l/r, unit
Freezing and thawing are separately billable
P9053
Plt, pher, l/r cmv-neg, irr
Freezing and thawing are separately billable
P9054
Blood, l/r, froz/degly/wash
Freezing and thawing codes not separately billable
P9055
Plt, aph/pher, l/r, cmv-neg
Freezing and thawing are separately billable
P9056
Blood, l/r, irradiated
Freezing and thawing are separately billable
P9057
RBC, frz/deg/wsh, l/r, irrad
Freezing and thawing codes not separately billable
P9058
RBC, l/r, cmv-neg, irrad
Freezing and thawing are separately billable
P9059
Plasma, frz between 8-24hour
Freezing and thawing codes not separately billable
P9060
Fr frz plasma donor retested
Freezing and thawing codes not separately billable
To report charges for transfusion services, OPPS providers should bill the appropriate Procedure code for the specific transfusion service provided under Revenue Code 391 (Blood Administration). Transfusion services codes are billed on a per service basis, and not by the number of units of blood product transfused. For payment, a blood product HCPCS code is required when billing a transfusion service code. A transfusion APC will be paid to the OPPS provider for transfusing blood products once per day, regardless of the number of units or different types of blood products transfused.
Billing for Pheresis and Apheresis Services
Apheresis/pheresis services are billed on a per visit basis and not on a per unit basis. OPPS providers should report the charge for an Evaluation and Management (E&M) visit only if there is a separately identifiable E&M service performed which extends beyond the evaluation and management portion of a typical apheresis/pheresis service. If the OPPS provider is billing an E&M visit code in addition to the apheresis/pheresis service, it may be appropriate to use the HCPCS modifier -25.
Billing for Autologous Stem Cell Transplants
The hospital bills and shows all charges for autologous stem cell harvesting, processing, and transplant procedures based on the status of the patient (i.e., inpatient or outpatient) when the services are furnished. It shows charges for the actual transplant, described by the appropriate ICD procedure or Procedure codes in Revenue Center 0362 (Operating Room Services; Organ Transplant, Other than Kidney) or another appropriate cost center.
The Procedure codes describing autologous stem cell harvesting procedures may be billed and are separately payable under the Outpatient Prospective Payment System (OPPS) when provided in the hospital outpatient setting of care. Autologous harvesting procedures are distinct from the acquisition services described in Pub. 100-04, Chapter 3, §90.3.1 and §231.11 of this chapter for allogeneic stem cell transplants, which include services provided when stem cells are obtained from a donor and not from the patient undergoing the stem cell transplant.
The Procedure codes describing autologous stem cell processing procedures also may be billed and are separately payable under the OPPS when provided to hospital outpatients.
No comments:
Post a Comment