On June 3, 2000 the e-network was asked a question regarding billing practices of transfusion medicine specialists who might use the CPT code, 1886079. The member stated that examples of allowable professional billings using this code included authorization for deviation from standard blood banking procedures including switching ABO blood types during transfusion therapy and the authorizing of a platelet drip. The individual asking this question wanted to get feedback from the network regarding other defined situations and transfusion practices that might be billed using this CPT code. This CPT code is different from 1880500, clinical pathology consult, limited.

The following (slightly paraphrased) replies were received:

1. We also use the same CPT code for the professional charges cited in the question. I wonder if the medical directors at your facility always document the authorizations on the patient's chart before a charge is sent through?

2. This code would also cover emergency release of uncrossmatched blood, crossmatch incompatible blood (as with a defined clinically insignificant antibody, or a least incompatible scenario with a warm autoantibody, etc In all cases a documented note must be present for billing.

3. I use this code sparingly. The primary instance is for approval to use least-incompatible transfusions. This most often arises in patients with autoantibodies, but sometimes occurs when needing to transfuse patients with certain broadly reactive insignificant antibodies.

4. We use it for providing HLA-matched platelets and for granulocyte transfusion.

ADDENDA June 18, 2000

5. With this CPT code, it is NOT necessary for an individual order on a patient from the attending. It is necessary that there be the following:

1. A deviation from the usual practice of the transfusion service, and
2. that the transfusion service MD documented in writing his/her allowing the deviation. Such a note should be in the patient's record, not just in the transfusion service.

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator