Health Information Management

Bill 36430 regardless of where the patient was admitted

APCs Insider, October 12, 2007

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

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.

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular