Pathology/Lab Coding Alert

Use new code for matching blood through lab information system

The electronic compatibility test may save time and resources, but it doesn't save money if you don't get paid.
 
Now that CPT 2006 adds CPT 86923 for the procedure, you can learn how to get paid for the electronic crossmatch in uncomplicated transfusion cases.

Bill 86923 for Computer Crossmatch

In addition to type and screen, many hospitals use the common spin-technique compatibility test before transfusing blood (86920, Compatibility test each unit; immediate spin technique). But staff can work more efficiently when they do not need to pull segments and make red-blood-cell suspensions for the crossmatch, says Suzanne H. Butch, MA, MT(ASCP)SBB, administrative manager at University of Michigan's Blood Bank and Transfusion Services in Ann Arbor.
 
That's how 86923 (Compatibility test each unit; electronic) can help ease the transfusion work load for patients with two documented blood types and no clinically significant antibodies. CMS will pay $12.91 for the service.
 
Old way: Before CPT added the code, labs had to report the service with 99090 (Analysis of clinical data stored in computers [e.g., ECGs, blood pressures, hemato-logic data) -- which didn't get paid, Butch says.

'Type and Screen' Comes First

Before receiving a blood transfusion, patients must undergo the following testing to avoid a dangerous transfusion reaction:
 
Blood typing -- "Blood type" refers to the presence or absence of certain antigens on the red-blood cell (RBC) surface. Of the more than 600 known antigens, the most significant in terms of transfusion compatibility are A, B and RhO(D). Two tests identify the patient's blood type under the ABO and Rhesus (Rh) systems.
 
• 86900 -- Blood typing; ABO
 
This test determines whether the patient is type A, B, AB or O.
 
• 86901 -- Blood typing; Rh(D)
 
This test determines whether the patient is Rh positive or negative (whether the patient has or does not have the RhO[D] antigen).
 
Patients must receive a compatible blood type in transfusion -- one that will not result in an antigen/antibody reaction.
 
Antibody screen -- Although not frequently occurring, certain antibodies to other antigens from the Rh or other systems, such as Duffy, Kell and Kidd, can also cause a transfusion reaction. "An antibody screen will detect the most common atypical IgG and some IgM antibodies," says Catherine Saporito, MT (ASCP), SBB, blood bank manager at University of Illinois Hospital in Chicago. A patient's blood undergoes the following test before a transfusion: 86850 -- Antibody screen, RBC, each serum technique.

A negative antibody screen means that the patient has none of these common antibodies that could cause a transfusion reaction. A positive antibody screen means the presence of some antibody in the blood. 

Know When to Use Compatibility Tests

With a known blood type and a negative antibody screen, many hospitals perform an 86920 spin crossmatch. The procedure involves mixing serum from the patient with donor red-blood cells in a test tube. If agglutination (clumping) occurs, the blood is not compatible, and you should not proceed with the transfusion using that donor blood.
 
New rules: Studies indicate that the risk of a transfusion reaction is exceedingly small if the patient receives a compatible blood type and has a negative antibody screen and history. That's why the American Association of Blood Banks (AABB) approved standards that allow a transfusion with no serologic crossmatch for a patient with two blood typings on file and no clinically significant antibodies, Butch says.
 
New code: To "skip" the 86920 crossmatch for a patient with no clinically significant antibodies, the hospital can issue donor blood using a computer. The lab information system must be set up to detect a "mismatch" between the donor and recipient ABO and Rh blood types and antibody history -- a so-called "computer crossmatch." Report the service as 86923. This "electronic" compatibility test is not a lab test at all; it involves only computer detection of an ABO or Rh mismatch, and it is not a serologic crossmatch.
 
What if the patient has known antibodies based on history or positive antibody screen and identification? "You cannot use the 86923 crossmatch for a recipient with clinically significant antibodies," Butch says.
 
Labs must perform an antiglobulin crossmatch (86922, Compatibility test each unit; antiglobulin technique) to ensure compatibility between donor and recipient blood when known antibodies are present.
 
Do this: Regardless of which compatibility test you perform (86920, 86921, 86922 or 86923), you should charge one unit of the code for each unit of blood that you crossmatch. For instance, if you electronically crossmatch and transfuse three units, report 86923 x 3.
 
Pitfall: The unit of service is different for the crossmatch than for the transfusion service itself. Regardless of how many blood units you use, report 36430 (Transfusion, blood or blood components) only once each day the patient receives a transfusion.

Watch Out for NCCI Edits

Depending on the results of patient type and screen testing and the hospital protocol, staff may perform a serologic compatibility test such as 86920, 86921 or 86922. Or the hospital may carry out a "computer crossmatch." But you should not charge for an electronic crossmatch (86923) in addition to any other type of crossmatch for the same donor unit, Butch says. A parenthetic CPT note states, "Do not use 86923 in conjunction with 86920-86922 for the same unit crossmatch."
 
National Correct Coding Initiative edits confirm this restriction, bundling 86923 as a component of the other crossmatch codes (86920-86922). Even if the hospital uses the computer to match the donor and recipient blood before performing the serological crossmatch, Medicare considers the electronic service to be part of the lab compatibility test.

Don't Miss Tests After Positive Antibody Screen

If the lab performs additional tests on the patient's blood following a positive antibody screen, don't forget to capture the additional work for payment. Positive results of the 86850 test indicate that the patient has antibodies that could be significant to a transfusion reaction. That's why labs often perform additional testing to further identify and quantify the antibodies.
 
For instance: The lab might identify antibodies (86870, Antibody identification, RBC antibodies, each panel for each serum technique) and quantify them (86886, Antihuman globulin test [Coombs test]; indirect, titer, each antiserum), Butch says. You must report each additional procedure code if you want to get paid for the service.