Oncology & Hematology Coding Alert

Question: Should I base the number of units for 36430 on the number of blood product units?

Idaho Subscriber

Answer: You should report only one unit of 36430 (Transfusion, blood or blood components), regardless of the number of blood product units (pints) you use.

Example: Your patient requires two units of packed red blood cells and two units of fresh frozen plasma. Your freestanding center supplies both the service and the blood products. Report one unit of 36430, two units of P9021 (Red blood cells, each unit) and two units of P9017 (Fresh frozen plasma [single donor], frozen within 8 hours of collection, each unit).

ABN warning: Unless you code for both the transfusion and the blood product, some payers won't pay. 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 should state 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.

Key: Don't look at an ABN as a blanket "collect from the patient" notice. You can use an ABN when the service is medically necessary in some circumstances but not in others, and the patient opts to pay. You can find more ABN info at http://www.cms.hhs.gov/MLNProducts/Downloads/ABN_READERS.pdf.

-- 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 past-president of the American Academy of Professional Coders National Advisory Board.