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Bill 36430 regardless of where the patient was admitted

APCs Weekly Monitor, October 12, 2007

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QUESTION: A doctor receives laboratory test results on a post transplant patient. The doctor tells the patient he or she needs a transfusion.

"Patient found to have low Hemoglobin on labs drawn today. Attempted to schedule outpatient transfusion for 4/10/07, but the unit was unable to accommodate. Emergency room triage called and Clinical Decision Unit (CDU) bed management accepted the patient for transfusion of 2 units of leukopoor irradiated blood transfusion."

The patient spends a total of 19 hours in the CDU. The first unit was transfused in two hours and 50 minutes. The second unit transfused in two hours and 25 minutes. The emergency department (ED) coders bill for the CDU.

How should we code this scenario? We follow the ACEP guidelines when billing for ED visits.

ANSWER: Regardless of where the patient was admitted to the ED, outpatient unit, clinic, etc., the doctor saw the patient and treated him or her for a blood transfusion, which should be billed as such. The facility would bill the patient with CPT code 36430 for the transfusion administration regardless of the number of units infused and P9040 x2 for leukopoor red blood cells (RBC) irradiated blood units. Though RBCs was not stated, it is most common. There is no ED or other visit charge, because the patient was already seen and evaluated by his or her doctor prior to the visit to HFHS. Why the patient was in the unit for 19 hours but was only transfused for approximately five hours is unclear. Was there a complication or transfusion reaction? Did the patient have another condition that required treatment? If so, then other procedures and/or visits may apply.

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