Billing for Blood Charges under the Outpatient Prospective Payment System The Health Care Financing Administration (HCFA) has addressed the issue of how to bill for charges related to blood in states where the blood product itself is not purchased. The following information is quoted directly from a Q&A on the HCFA Web site, http://www.hcfa.gov/medlearn/faqclaim.htm. This information applies to hospital outpatient services paid under OPPS for dates of service on or after August 1, 2000. Q. 110. How are we supposed to bill for blood use? Our state doesn’t allow blood to be sold, so we don’t have a charge for blood, only for processing and storage. A. 110. We have changed the way blood use is shown. We will pay for the administration of blood using code 36430 (billed once per day for all transfusions) in revenue code 391. Bill for blood and blood products using the range of HCPCS codes provided for them, in Revenue Codes 380-389. The charge you show should reflect the charge made by the blood bank (if your hospital purchases blood rather than using an in-house blood bank). We realize that in most cases the charge is not for the blood per se, but rather for the costs associated with recruiting donors, hiring phlebotomists, testing blood for infective agents, and further processing, storage, and transportation. You may also bill the laboratory codes for typing and cross matching and other services related to the patient who receives the blood. You may not bill for blood processing and storage, since those costs are captured in the payment rate assigned to the blood or blood product. If your hospital runs its own blood bank, for some or all of the blood you use, you should follow the same process, since if you bill for processing and storage, rather than units of blood, your claims will not be paid. We have inserted an edit so that blood or a blood product must be billed when blood administration is billed. Except in those instances in which blood itself is paid for, the blood deductible is not applied. Fiscal intermediaries will change their revenue code edits to reflect this change. Billing Instructions Administration of blood (transfusion) -- For all providers
Blood Product/Storage/Processing For providers who bill for the blood product (Cannot be used by Connecticut or New York).
Note: Delaware providers should not bill additional lines for blood storage and processing since these costs are captured in the payment rate assigned to the blood or blood product HCPCS code. For providers who do not bill for the blood product.
*We are clarifying with HCFA whether Revenue Codes 380-389 should be used. Currently we can only accept Revenue Code 390. Additional information will be published as soon as it becomes available. Additional Billing Information
HCPCS codes Currently Available for Billing Blood Blood/Blood Products Classified in Separate APCs The following list of blood/blood products and drugs are classified in separate APCs. Since these are classified in separate APCs, they are not eligible for thetransitional pass-through payment system.
Blood/Blood Products Classified in Separate APCs (Effective October 1, 2000) The following blood/blood products are classified in separate APCs. Since these are classified in separate APCs, they are not eligible for transitional pass-through payments.
CPT codes and descriptions only are copyright 2000 American Medical Association (or such other date publication of CPT)
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