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Oncology & Hematology Coding Alert

Reader Question:

Watch 36430 Units -- RACs Are

Published on Tue Jul 27, 2010

Question:

If we give two units of blood, should we report 36430 twice?

Arkansas Subscriber

Answer:

No. You should report 36430 (Transfusion, blood or blood components) only once.

Support: CPT Assistant (March 2001) states you should report 36430 only once per transfusion regardless of how many units you administer. In addition, 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.

Beware: The RAC auditor for your region (Region C), Connolly Healthcare, has listed blood transfusions as one of its approved issues. Specifically, the RAC will check that providers bill only one unit of 36430, and other specified blood transfusion codes, per session. You can review Region C's approved issues at http://www.connollyhealthcare.com/RAC/pages/approved_issues.aspx.

Region A: RAC DCS, Region B: RAC CGI, and Region D: RAC HDI have listed blood transfusion code units as an issue under review, as well. You can find their issues posted online:

DCS: http://www.dcsrac.com/issues.html

CGI: http://racb.cgi.com/Issues.aspx

HDI: https://racinfo.healthdatainsights.com/Public1/NewIssues.aspx. 

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