A California physician reports that she would like to issue a bill for the medical evaluation of patients who request autologous blood collection services at her hospital. She states that she currently examines patients who request that autologous blood be collected for scheduled surgery at her hospital, and that she issues a written report to document her medical evaluation and opinion. Do any colleagues bill for this service, and if so, what CPT code is used? If a bill is issued, is it given to the patient, their insurance company, or the hospital in which the collection occurred?

The following comments have been received.

ADDENDA Mar. 31, 2006

1. A physician along the East Coast also wonders how she could bill for the medical assessment of a potential autologous donor's medical status in advance of an autologous blood donation. She reports that sometimes she must spend considerable time assessing a patient who has a medical condition that might make the collection of a unit of autologous blood risky. She reports two tragic stories of patients who wanted to bank their own blood, but (in the opinion of a blood bank physician) had inadequate pre-operative evaluations. One patient had cardiac risk factors that were not adequately evaluated (no stress test or any studies beyond a resting EKG). The other patient had an unexplained anemia. In both cases a blood bank physician recommended that a more thorough medical evaluation be done before undergoing surgery or autologous blood donation. In each case the patient and surgeon elected to proceed without additional medical evaluation, although autologous blood donations were cancelled. The first patient died from an infra-operative myocardial infarction. The second patient had a prolonged post-operative course complicated by infections; eventually the patient was diagnosed with a hematologic malignancy. The physician hypothesizes that if pre-donation medical evaluations for autologous blood donation could be billed, the opinions rendered would garner recognition as valuable medical opinions, rather than merely be considered a 'yes' or 'no' response to a request for a technical procedure (phlebotomy).

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