Question: Medicare has started denying our multiple blood unit claims (not the transfusion), saying we need a modifier, but I don’t see an appropriate one in my HCPCS book. What should I be using?
Arizona Subscriber
Answer: If you are purchasing the blood from a community blood bank or run your own blood bank and assess a charge for the blood or blood product collected, you should use modifier BL (Special acquisition of blood and blood products). In July 2005, CMS published clarification on how you should be reporting blood products under the hospital outpatient prospective payment system (OPPS).
If your facility pays a community blood bank for the blood product or collects the blood or blood product in your own blood bank and also assesses a charge for the blood, you need to separately charge for the units of blood and the related processing.
How it works: CMS instructs you to report the charges for the blood product itself, when purchased, using revenue code series 038x with the line item date of service (LIDOS), the number of units transfused, and the appropriate blood product HCPCS code and HCPCS modifier BL. Then report charges for processing and storage services on a separate line using revenue code 0390 or 0399 with the LIDOS, the number of units transfused, and the appropriate blood product HCPCS code and HCPCS modifier BL.
Note: Most facilities do not incur a cost for the product itself from a community blood bank, but instead a cost for administrative handling, preparation, and storage of the product. In this case, report the product under revenue code 0390 without modifier BL.
-- Reader Questions reviewed by Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. in Raleigh, N.C.
