Oncology & Hematology Coding Alert

Here’s what those HCPCS Level II blood product codes describe.

Transfusions play a key part in cancer treatments. They can be administered pre- or post-surgery to replace lost blood, and platelet transfusions can increase a patient’s platelet count when it drops dangerously low due to cancer or chemotherapy. According to the American Red Cross and American Cancer Society, people battling cancer — particularly those undergoing chemotherapy — use one quarter of the nation’s blood supply.

So, understanding how to code transfusions and their component services is critical to precise oncology coding. To help you get it all right, here are four tips you can use every time you need to document these procedures.

Tip 1: Know How to Report the Transfusion

When a patient’s platelet counts are low, the patient may receive platelet transfusions as protection against bleeding. Additionally, the patient may receive red blood cell replacement to combat fatigue caused by chemotherapy-induced anemia or disease-induced anemia. When this occurs, you’ll code the simple transfusion using 36430 (Transfusion, blood or blood components), which is typical for an infusion involving patients other than newborns for partial exchange.

But remember, you can report the code “only one time per transfusion,” regardless of how many units of blood or blood products your provider transfuses (see CPT^® Assistant, Volume 3, Issue 11, page 10 (March 2001)). CMS’s medically unlikely edits (MUEs) list a limit of 1 for 36430, meaning that’s the maximum number of units the majority of patients should require.

Billing alert 1: You won’t be able to bill separately for any supplies associated with the procedure. CPT^® guidelines for vascular injection procedures such as transfusions tell you that the services “include necessary local anesthesia, introduction of needles or catheter … and/or necessary pre- and post-injection care specifically related to the injection procedure.” For transfusions, billing also typically includes such supplies as central venous access devices, infusion pumps, blood warmers, rapid infusers, and pressure devices, for which you should not bill separately.

Billing alert 2: Transfusion of blood and/or blood products is only submitted with code 36430 when administered by a physician or qualified assistant employed by and under the supervision of a physician. Services rendered by an assistant would need to follow incident-to guidelines for Medicare patients and comply with other payer policies if required. Preparation of blood and blood products is included in the service for administration of the agent. Professional charges/codes for the transfusion of blood or blood products should not be submitted when administered by hospital or home health agency personnel.

Tip 2: Know How to Report These Other Common Transfusions

For patient’s whose bone marrow is damaged and who cannot make red blood cells, white blood cells, and platelets that the body needs, you’ll report the stem cell transplant with either 38240 (Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor) or 38241 (… autologous transplantation).

For patients with sickle cell anemia or jaundice due to secondary liver cancer, your provider may perform an exchange transfusion. This differs from a regular transfusion in that it both adds and removes blood, so instead of 36430, you’ll use 36455 (Exchange transfusion, blood; other than newborn) for the procedure when performed on patients other than newborns.

Tip 3: Know How to Report Autologous Collection

Blood used in transfusions typically comes from an outside source, such as a community blood bank or a hospital. However, in cases when your oncology practice performs autologous collection — the collection of blood from patients themselves — you can bill for both the process of collection along with the storage necessary to hold the blood until it is transfused into the patient using 86890 (Autologous blood or component, collection processing and storage; predeposited).

You might also be able to use 86891 (Autologous blood or component, collection processing and storage; intra- or postoperative salvage). The difference between the codes lies in the collection method: For 86891, the provider collects the patient’s blood, or components such as platelets, while the patient is undergoing surgery.

Don’t forget the Dx: In addition to reporting a code that documents the medical condition that has necessitated the patient’s transfusion, when patients donate their own blood, you’ll also use a code from Z52.01- (Autologous blood donor) depending on the kind of blood product produced from the donation. These could include whole blood (Z52.010), stem cells (Z52.011), or other blood products (Z52.018).