Oncology & Hematology Coding Alert

Heads up: Bill one unit of 36430 for every transfusion.

Platelet transfusion is not the same as blood transfusion. Platelets are a component of blood, and you have specific CPT^® and HCPCS codes from which to choose. Find out how to keep these claims picture perfect.

Turn to Blood Component Transfusion Code

When a physician orders and performs a platelet transfusion, submit code 36430 (Transfusion, blood or blood components). According to the CPT^® Assistant (March 2001), you should only report 36430 once per transfusion, regardless of how many units are administered. Medicare pays providers for only one blood administration service per day, regardless of the number or volume of different blood products transfused.

Table 1 lists the HCPCS codes for platelet transfusions. These codes are only reported for payment under OPPS. The hospital chargemaster should have the items offered at your hospital for the UB hospital facility claim. These codes are not reported by the physician overseeing the transfusion as these items do not represent a cost to the physician in the hospital setting. On the UB claim, be sure to select the best code depending upon how the platelet concentrate was prepared.

Leukocyte reduction: Leukocyte reduction may be done before storage of platelets or before transfusion. Pre-storage leukocyte reduction may be done within 24 hours of collecting the blood by using inline filters at the time, or after, collection.

Pre-transfusion leukocyte reduction is also called bedside leukoreduction. This is done prior to transfusion by using gravity-based filters at time of transfusion (less preferred) or by transfusion service prior to issuing the platelets.

Why leukocyte reduction? When collecting platelets, white blood cells are collected as an unwanted component due to their high relative densities. These incidentally collected white blood cells, when transfused with platelets, can cause rejection problems. Leukocyte reduction is a process that reduces the counts of white blood cells before platelet transfusions. Leukocyte reduction helps to prevent alloimmunization to donor HLA antigens, graft rejection, immune mediated destruction of platelets, febrile non-hemolytic transfusion reactions (FNHTR), and cytomegalovirus (CMV) transmission.

Why irradiation? Irradiation are options for code choice on the list. Where the process involved irradiation it is done to prevent transfusion associated graft vs. host disease (TA-GVHD) as it causes DNA crosslinks, thereby preventing lymphocyte replication without significantly damaging red blood cell, platelet or granulocyte function.

Don’t Count Blood Deductible

The Medicare Part B benefit may not be made for the first three pints of whole blood, or equivalent units of packed red cells, received by a Medicare beneficiary in a calendar year. The blood deductible only applies to whole blood or packed red cells.

See these source documents for further information and explanation:

• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 231.1 - 231.8
• CMS, IOM, Publication 100-01, Medicare General Information, Eligibility and Entitlement, Chapter3, Section 20.5