Billing for Split Unit of Blood

Billing for Split Unit of Blood

(Rev. 1487, Issued: 04-08-08, Effective: 04-01-08, implementation: 04-07-08)

HCPCS code P9011 was created to identify situations where one unit of blood or a blood product is split, and some portion of the unit is transfused to one patient while the other portions are transfused to other patients (or to the same patient at other times). When a patient receives a transfusion of a split unit of blood or blood product, OPPS providers should bill P9011 for the blood product transfused, as well as CPT 86985 (Splitting,blood products) for each splitting procedure performed to prepare the blood product for a specific patient.

Providers should bill split units of packed red cells and whole blood using Revenue Code 389 (Other blood), and should not use Revenue Codes 381 (Packed red cells) or 382 (Whole blood). Providers should bill split units of other blood products using the applicable revenue codes for the blood product type, such as 383 (Plasma) or 384 (Platelets), rather than 389. Reporting revenue codes according to these specifications will ensure the Medicare beneficiary's blood deductible is applied correctly.

EXAMPLE:

OPPS provider splits off a 100cc aliquot from a 250 cc unit of leukocyte-reduced red blood cells for a transfusion to Patient X. The hospital then splits off an 80cc aliquot of the remaining unit for a transfusion to Patient Y. At a later time, the remaining 70cc from the unit is transfused to Patient Z.

In billing for the services for Patient X and Patient Y, the OPPS provider should report the charges by billing P9011 and 86985 in addition to the CPT code for the transfusion service, because a specific splitting service was required to prepare a split unit for transfusion to each of those patients. However, the OPPS provider should report only P9011 and the CPT code for the transfusion service for Patient Z because no additional splitting was necessary to prepare the split unit for transfusion to Patient Z. The OPPS provider should bill Revenue Code 0389 for each split unit of the leukocyte-reduced red blood cells that was transfused.

 http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c04.pdf

More Items in January 2015

• Jan 30, 2015
  PQRS CMS.gov Interactive Timeline - Don't Miss the Deadlines!
• Jan 30, 2015
  CMS Opt-Out Regulations and Guidelines
• Jan 28, 2015
  Value Set Authority Center (VSAC)
• Jan 28, 2015
  Underdosing - a New Clinical Concept in ICD-10 codes T36 - T50
• Jan 27, 2015
  Medicare to Change How it Pays Doctors and Hospitals
• Jan 23, 2015
  New: 2015 January Edition of the Medicare Quarterly Provider Compliance Newsletter
• Jan 23, 2015
  Eligible Professional 2014 Attestation Deadline on February 28; Prepare for Attestation
• Jan 14, 2015
  Aligning the Way Providers are Paid to Reward Value Rather than Volume (Value Based Modifiers)
• Jan 14, 2015
  What is an LMRP and Where Can I Find Them?
• Jan 06, 2015
  Holding of 2015 Date-of-Service Claims for Services Paid Under the 2015 Medicare Physician Fee Schedule
• Jan 06, 2015
  Modifier -59 Could Impact Your Reimbursement - New Coding Requirements!

To view more items select a month from our "Items by Month" list.

Or view documentation, coding and billing articles.