Pathology/Lab Coding Alert

See when the pathologist joins the fray.

Blood transfusions are a key part of treatment for cancer or other conditions, and your clinical lab and pathologists may be involved every step of the way. That’s why you need to learn the ropes for coding procedures from blood collection to transfusion and everything in between.

Learn These Collection Codes

Although blood banks are the source of most blood products for transfusion, labs sometimes perform collection services for special cases.

For instance, certain patients need their own blood collected and stored for transfusion at a later date. That’s called an autologous collection, and CPT^® has a couple of codes for that, as follows:

• 86890 (Autologous blood or component, collection processing and storage; predeposited)
• 86891 (… intra- or postoperative salvage)

The difference between the codes lies in the collection method and timing. For 86891, the provider collects or salvages the patient’s blood, or components such as platelets, during or immediately after surgery.

Don’t forget the Dx: In addition to reporting a code that documents the medical condition that has necessitated the patient’s transfusion, when patients donate their own blood, you’ll also use a code from Z52.01- (Autologous blood donor) depending on the kind of blood product produced from the donation. These could include whole blood (Z52.010), stem cells (Z52.011), or other blood products (Z52.018).

Move on to Type and Screen

Before receiving a blood transfusion, patients must undergo testing to determine their blood type to avoid possible transfusion reactions.

“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, serologic; ABO This test determines whether the patient is type A, B, AB, or O.
• 86901 — … 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).

Once the patient’s ABO and Rh blood type are known, clinicians typically order an antibody screen such as 86850 (Antibody screen, RBC, each serum technique). This test looks for common antibodies that may cause a transfusion reaction, even if the donor and recipient share the same blood type in the ABO and Rh systems.

A positive antibody screen means that red blood cell (RBC) antibodies are present in patient blood that could contraindicate a transfusion, but it does not identify the antibody. Following a positive RBC antibody screen, labs typically perform further testing to identify the antibodies present, such as 86870 (Antibody identification, RBC antibodies, each panel for each serum technique).

Know other methods: Blood typing by serologic methods isn’t the only testing option. Labs might also perform blood typing by molecular methods, and in those cases, you should report appropriate code(s), such as 81403 (Molecular pathology procedure, Level 4 …) for tests such as the following:

• Human erythrocyte antigen gene analyses (e.g., SLC14A1 [Kidd blood group], BCAM [Lutheran blood group], ICAM4 [Landsteiner-Wiener blood group], SLC4A1 [Diego blood group], AQP1 [Colton blood group], ERMAP [Scianna blood group], RHCE ]Rh blood group, CcEe antigens], KEL [Kell blood group], DARC [Duffy blood group], GYPA, GYPB, GYPE [MNS blood group], ART4 [Dombrock blood group]) (e.g., sickle-cell disease, thalassemia, hemolytic transfusion reactions, hemolytic disease of the fetus or newborn), common variants
• RHD (Rh blood group, D antigen) (e.g., hemolytic disease of the fetus and newborn, Rh maternal/fetal compatibility), deletion analysis (e.g., exons 4, 5, and 7, pseudogene)
• RHD (Rh blood group, D antigen) (e.g., hemolytic disease of the fetus and newborn, Rh maternal/fetal compatibility), deletion analysis (e.g., exons 4, 5, and 7, pseudogene), performed on cell-free fetal DNA in maternal blood.

“Make sure you report a code from 86900-86906 (Blood typing, serologic …) when your lab uses traditional serologic blood typing methods, and turn to 81403 for gene analysis blood typing tests,” says William Dettwyler, MT AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Oregon.

CPT^® also lists a host of proprietary laboratory analysis (PLA) codes for RBC antigen genotype analysis, such as 0182U-0201U (Red cell antigen … genotyping …) for blood groups ranging from Cromer blood group (CROM) to Yt blood group (YT).

Bottom line: Labs may perform many tests to ensure that patients receive a compatible blood type in transfusion — one that will not result in an antigen/antibody reaction.

Code the Transfusion

For transfusing blood or blood components, such as platelets, turn to 36430 (Transfusion, blood or blood components), in most cases.

Exceptions: For newborns or patients needing an “exchange” that includes removal of patient blood, turn to a code such as 36450 (Exchange transfusion, blood; newborn) or 36455 (… other than newborn)).

Units: You can report the transfusion using 36430 only one time per transfusion, regardless of how many units of blood or blood products your provider transfuses (see CPT^® Assistant, Volume 3, Issue 11). CMS’ medically unlikely edits (MUEs) list a limit of 1 for 36430.

Also, you should remember that “while there are various methods of blood transfusions — transfusion of homologous, autologous, or donor-directed blood — Medicare coverage does not make a distinction between them,” says Arlene Baril, MHA, RHIA, CHC, director of facility services for Pinnacle Enterprise Consulting Services in Dallas, Texas.

Supplies: You won’t be able to bill separately for any supplies associated with the transfusion procedure. CPT^® guidelines for vascular injection procedures such as transfusions tell you that the services “include necessary local anesthesia, introduction of needles or catheter … and/or necessary pre- and post-injection care specifically related to the injection procedure.” For transfusions, billing also typically includes such supplies as central venous access devices, infusion pumps, blood warmers, rapid infusers, and pressure devices. The service also includes preparation of blood and blood products.

Alert: You can bill 36430 only when administered by a physician or qualified assistant employed by and under the supervision of a physician. Services rendered by an assistant would need to follow incident-to guidelines for Medicare patients and comply with other payer policies if required. Don’t submit blood transfusion professional charges when administered by hospital or home health agency personnel.