A member of the e-network forum reported that his laboratory implemented a computerized system that is capable of performing a computer crossmatch. However, before administrative approval is granted to implement the computer crossmatch, his administration is curious to know if other hospitals have successfully implemented a reimbursement process for the computer crossmatch.

The following replies were received in response to the above query:

1. One blood banker reported that his facility implemented a computer crossmatch procedure, but has not been able to charge. He reports that his facility has substituted a 'type confirmation charge', but he did not mention if payments were received according to this alternative billing approach.

2. Another blood banker reported that he and others have attempted in the past several years to add a CPT code specifically for the computer crossmatch. This has been denied by AMA and CMS as there already exists a code to be used when the computer manages patient data (99090-Analysis of clinical data stored in computers). This is the only code that is available for use when an electronic crossmatch is performed and the prospect of a new code looks poor. CPT 99090 is a non-covered service for outpatients, but would be included as line item of DRG. Thus, it is not easy to determine if payment is made for each line item, which is why the responding blood banker supports a "special" computer crossmatch code to go with 39X RC for reimbursement analysis and completeness. The responding blood banker concludes by reporting that this is a topic for the next meeting with CMS on blood issues.

ADDENDA Mar. 27, 2002

3. A blood banker wrote that the lack of replies regarding the reimbursment for the performance of the computer crossmatch was quite interesting. His facility, too, finds itself in the midst of such a dilemma as the administration has halted efforts to implement the procedure, citing a significant future loss of generated revenues. The blood banker submitting this addendum wants to learn if anyone has any information to assist in the pursuit of the implementation of the procedure?

ADDENDA April 3, 2002

4. A Canadian blood banker is curious to learn how big a population base the ~2% of U.S. laboratories who perform a computer-assisted crossmatch serve, compared to the roughly 50% who use an immediate spin crossmatch and the roughly 48% who presumably continue to perform an antiglobulin crossmatch for patients without detectable alloantibodies. Perhaps the ~2% that use the computer crossmatch are larger facilities that serve a relatively huge population base. As an example, to use fictitious numbers, perhaps the 2% who use the computer crossmatch do the testing for 30% of the US population and the 48% that do the AHG crossmatch serve less than 10% of the population. Does any one know if any study has ever looked at pretransfusion testing practices from this perspective?

ADDENDA April 6, 2002

5. A blood banker from Michigan is of the opinion that larger hospitals have tended to adopt the immediate spin crossmatch and smaller hospitals have not. This opinion is based on a paper by Maffei LM et al. (Transfusion 1998). The Michigan blood banker continues by reporting that 7% of their electronic crossmatching is performed for patients who are outpatients. Consequently, they lose the crossmatch fee but gain an ABO confirmation fee for the unit since they had been failing to bill for that previously. For 90% of their patients who are DRG or contract reimbursed, it does not matter if they add a charge for a crossmatch or not. They receive the same reimbursement regardless of the cost to provide the care.

6. Another blood banker from Michigan wrote that as he recalls, Ira Shulman, MD in collaboration with Maffei, Johnson, and Steiner, published the very data that the Canadian correspondent is seeking (same reference as in 5., above). In Table 7 of their paper the number of institutions performing an IS crossmatch is shown relative to bed size. When you calculate the number as a percentage of hospitals in each bed size group there is a clear indication that larger hospitals are more progressive than smaller facilities. Only 29% of small hospitals (bed size 1-99) do an immediate spin crossmatch, whereas an immediate spin crossmatch is done in 80% of hospitals with a bed size >500. The Michigan blood banker comments that the data regarding electronic crossmatching are too small to be significant, but he strongly suspects there is an association with bed size.

Editor's note: The data mentioned above which were published in Transfusion are now more than FOUR years old, and the FDA has relaxed the rules to implement the computer crossmatch. I agree that it is likely that the largest facilities will probably favor implementing an electronic crossmatch (unless they will lose money doing so), and anticipate that the College of American Pathologists (CAP) will repeat a survey to collect current data on the use of the electronic crossmatch, the immediate spin crossmatch and the antiglobulin crossmatch.

Please submit comments to the e-Network Forum.

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