Health Information Management

Q/A: How should we report irradiated blood products?

APCs Insider, May 17, 2013

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Q: We have patients who have received a lot of blood and now the orders are for irradiated blood. We have been doing this in-house and our radiology department has been generating a charge. We just received a claim rejection for the combination of CPT® code 86945 (irradiation of blood product, each unit) and P9040 (red blood cells, leukocytes reduced, irradiated, each unit). We changed it to CPT 86945 and P9021 (red blood cells, each unit), but this was rejected for unbundling. How should we be reporting irradiated packed cells?

A: Whether the irradiation is done in your facility or somewhere else, HCPCS codes for many blood products include “irradiated” in the definition. One of these HCPCS codes is P9040. By definition, this code includes the irradiated service so the cost/charge for the irradiation should be included in the cost/charge of the blood product.
 Because a HCPCs code describes the irradiated product given, reporting CPT 86945 and P9021 is considered to be unbundling. The NCCI manual, chapter 12, notes:
Blood products are described by HCPCS level II P codes. If a P code describes an irradiated blood product, CPT code 86945 (irradiation of blood product, each unit) should not be reported separately since the P code includes irradiation of the blood product.
Be sure that the charge on your chargemaster for the blood product includes the cost of the irradiation so that CMS gets true cost data for future payment purposes and to meet Medicare regulations.
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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