Pathology/Lab Coding Alert
More Blood Collections Mean More Testing, Coding for Labs
After collection, all blood is put through a series of laboratory procedures, which identify units that can't be used and result in donor notification. Donors are advised to consult a healthcare professional regarding these test results. As increasing blood donations result in more identification of illness, other laboratories may see more requests for these same tests and must assign the correct codes to ensure appropriate ethical reimbursement for their services.
Each Unit Donated Is Tested
Within the blood-bank system, billing for donor blood incorporates these laboratory expenses into the cost of blood products, which are charged to the end user, not the donor. "The tested and processed blood is charged using codes such as P9021 (red blood cells, each unit) for allogenic donations and 86890 (autologous blood or component, collection processing and storage; predeposited) for autologous donations," says Carrie Smith, billing specialist for Sacramento Medical Foundation in Sacramento, Calif., which operates 14 blood-collection centers. Laboratories that do these tests for diagnostic services for patients will report the procedures using the CPT codes listed below.
After collection, every unit of blood is subjected to leukocyte reduction in which the white blood cells that can cause a non-life-threatening reaction in the blood recipient are filtered out from the red blood cells. This service is described by 36520 (therapeutic apheresis; plasma and/or cell exchange).
The following tests are then carried out on each unit:
Antibody Tests
"This combo test is to identify the presence of antibodies to the virus that causes AIDS," says Erschelle Newsome, BS, MT (ASCP), executive director of the Red Cross National Testing Laboratory in Atlanta.
"This test identifies antibodies to the virus associated with a rare form of leukemia called human T-cell lymphoma," Newsome says. "We also screen for two hepatitis antibodies."
"The last antibody screen is primarily for blood-group antibodies such as Kell, Rh, Lewis and others," Newsome says.
"Physicians may elect to request CMV testing for certain units for infants or immuno-compromised patients," Newsome says.
Nucleic Acid Tests
An emerging technology called nucleic acid testing (NAT) potentially allows for earlier detection of infection by identifying an antigen in the blood, perhaps before the body has begun to make antibodies. Although not yet approved by the Food and Drug Administration (FDA), the Red Cross tests donated units of blood using NAT under an Investigational New Drug application filed with the FDA. Two nucleic acid tests are carried out:
Antigen Tests
"Each unit of blood undergoes two antigen screening tests routinely," Newsome says:
Other Tests
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