This is a continuation of our previous blog World Blood Donor Day 2021 – “Give Blood and Keep the World Beating”

World Blood Donor’s Day is observed to remind us the donating blood can make a big difference in somebody’s life. Donated blood goes through several steps before it is ready for transfusion in a hospital or outpatient transfusion center. While some people need transfusion therapy for medical conditions such as hemaphilla or cancer, others may need blood transfusions for excessive bleeding from surgery or an injury. Understanding the key coding, billing, and reimbursement considerations for blood processing and related services is necessary to submit accurate claims and receive appropriate reimbursement. Many hospitals and other providers rely on outsource medical billing companies to code and bill accurately and consistently for blood donation, blood products, and transfusions provided to patients.

Medical Codes for Blood Donors and Blood-related Services

  • ICD-10 Codes for Blood Donors: These diagnosis codes come under the category Z52 Donors of organs and tissues.

    Z52.0 Blood donor
    Z52.00 Unspecified blood donor
    Z52.000 Unspecified donor, whole blood
    Z52.001 Unspecified donor, stem cells
    Z52.008 Unspecified donor, other blood
    Z52.01 Autologous blood donor
    Z52.010 Autologous donor, whole blood
    Z52.011 Autologous donor, stem cells
    Z52.018 Autologous donor, other blood
    Z52.09 Other blood donor
    Z52.090 …… whole blood
    Z52.091 …… stem cells
    Z52.098 …… other blood

  • Coding Blood Transfusions

    In a comprehensive and updated Billing Guide for Blood Products and Related Services published July, 2020, the American Association of Blood Banks (AABB) provides guidance for coding and billing for blood products and related services. The AABB notes that reporting services have become increasingly complex due the availability of many types of blood products. ICD-10 diagnosis codes, ICD 10 PCS procedure codes, revenue codes, HCPCS codes and CPT codes are used to report blood transfusions.

    • ICD-10 Codes – One or more ICD-10-CM diagnosis code are used to describe the patient’s condition in claims. Blood products can be billed using different types of diagnosis codes based on the situation that warrants the blood transfusion.
    • ICD-10-PCS Procedure Codes – ICD-10-PCS procedure codes are located in the 302 series of ICD-10-PCS and used in the hospital inpatient setting. Examples of these include:

      30233N1 – Transfusion of Nonautologous Red Blood Cells into Peripheral Vein, Percutaneous Approach
      30240R1 – Transfusion of Nonautologous Platelets into Central Vein, Open Approach

      Depending on the services rendered and the patient’s condition, providers can report one or more codes as appropriate. Adequate medical record documentation is required to support the assigned codes.

    • Revenue Codes – All hospital (inpatient and outpatient) claims must include a revenue code for supplies and services to specific cost centers within the facility. Here are three examples of the 4-digit revenue codes:

      0390 (Blood and blood component administration, processing, and storage; general classification) for transfused blood products carrying only a processing fee.
      0391 (Blood and blood component administration, processing, and storage; administration) for the transfusion procedure (if the transfusion is reported as a separate line item).
      Series 030X (Laboratory) for patient-specific laboratory services performed on blood units (if the service is reported as a separate line item) e.g., antigen typing

    • HCPCS Codes – HCPCS P-codes represent transfused blood products in hospitals (outpatient), physician offices, certain other care settings. The appropriate HCPCS code(s) to describe the product(s) should be reported and supported by proper medical record documentation. Examples:

      P9021 Red Blood Cells
      P9011 Red Blood Cells Neonate (Quad)
      P9016 Red Blood Cells
      P9019 Leukoreduced Platelets
      P9010 Whole Blood
      P9071 Whole Blood Plasma (single donor), pathogen reduced, frozen, each unit
      P9070 Plasma, pooled, multiple donor, pathogen reduced, frozen, each unit

    • CPT Codes: CPT codes are used on claims to report procedures performed in hospital outpatient settings, physicians in all settings, physician offices, and other specific care settings. The most commonly used code for transfusion procedures is CPT code 36430, Transfusion, blood, or blood components. Other codes:

      36440 Push transfusion, blood, 2 years or under
      36450 Exchange transfusion, blood, newborn
      36455 Exchange transfusion, blood, other than newborn
      36456 Partial exchange transfusion, blood, plasma, or crystalloid necessitating the skill of a physician or other qualified health-care professional, newborn
      36460 Transfusion, intrauterine, fetal

Points to Note when Billing for Blood and Transfusion Services

  • Coverage policies for hospital and physician services typically depend on whether the patient’s condition or proposed treatment is medically necessary and therefore eligible for reimbursement by the patient’s health plan.
  • While all types of medically necessary blood transfusions are covered by Medicare in hospital inpatient and outpatient settings, blood products and related services normally covered but not paid separately under all-inclusive bundled payments.
  • To ensure correct coding and billing of services, providers should know which blood-related products and services will be covered by payers as well as payer rules pertaining their geographical location.
  • CPT and HCPCS codes and CPT/HCPCS modifiers are for use only in an outpatient setting. These codes and modifiers are not used in an inpatient setting.
  • There may be coverage restrictions for various blood-related services. CPT and HCPCS codes may be subject to National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits and Medically Unlikely Edits (MUEs), and other types of coding edits.
  • Medicare allows hospitals to bill for blood processing costs for units transfused to patients, but does not allow them to bill for processing and storage costs for units that are not transfused.

There are various other considerations and rules for billing blood products and transfusion services. An experienced medical billing company can help providers report the right codes, bill services correctly, and receive appropriate payment for services rendered.