Oncology & Hematology Coding Alert
READER QUESTION ~ Bone Up on 36430 Unit Rule
Question: If we administer three units of a blood product, should I report three units of 36430? Answer: You should only report one unit of 36430 (Transfusion, blood or blood components) regardless of how many blood product units you use. The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the American Academy of Professional Coders National Advisory Board.
Nevada Subscriber
So if your freestanding center supplies both the service and the blood products for a patient who receives three units of packed red blood cells and three units of fresh frozen plasma, report one unit of 36430, three units of P9021 (Red blood cells, each unit), and three units of P9017 (Fresh frozen plasma [single donor], frozen within eight hours of collection, each unit).
Remember: Carriers often won't pay unless you code for both the transfusion and the blood product. If you-re a freestanding center that performs a transfusion, but the hospital supplies the blood, be sure to get an ABN in which the patient agrees to cover any charges Medicare won-t. The ABN states that you suspect Medicare won't pay for the service and the patient must choose whether he is willing to receive the service knowing he may have to pay.
You should also include an estimate of the cost, have the patient sign and date the document, and give the patient a copy for his records. Watch for: Some private insurers accept -waivers of liability- similar to the ABN, so find out if your patient's insurance offers this reimbursement safeguard.
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Question: If we administer three units of a blood product, should I report three units [...]
