Pathology/Lab Coding Alert

Question: Could you please explain how we should bill for typing by serology for a bone marrow recipient and three potential donors in the family?

Codify Subscriber

Answer: Many payers restrict initial testing to A, B, and DR antigens to establish bone marrow transplant donor suitability. Assuming that you’re testing the recipient and the potential donors for multiple A, B and DR antigens, you should bill each person’s tests as follows:

• For multiple A and B antigens, report one unit of 86813 (HLA typing; A, B, or C, multiple antigens)
  
• For multiple DR antigens, report one unit of 86817 (… DR/DQ, multiple antigens)
  

You should only report one unit of each because the codes describe “multiple antigens.”

Caution: You’ll need to get specific information from your payer about billing and coverage issues. Typically, a bone marrow transplant recipient has a charge file that chronicles services involving the transplant, including tissue typing services for potential donors. These charges are collected into a revenue class for the transplant, and become part of the Diagnosis Related Group (DRG) for inpatient services.

Like blood typing, tissue typing needs to be done only once in a person’s lifetime, so the information is pulled from a bone marrow transplant registry if the potential donor has already been tested.