Q&A: Billing for transplant donor services
Q: It is my understanding that for donor-related services, charges should be captured and held until the transplant occurs. Then, the donor charges should be included with the transplant recipient claim with revenue code 815.
However, I am seeking clarification on how to handle charges for services that occur for a donor who is an unsuccessful match. Should the charges for services provided to a potential donor who is an unsuccessful match also be included on the transplant recipient claim or should they be adjusted and just included on the cost report?
A: Yes, all donor search charges, including those incurred for working up a donor who does not turn out to be a match, are to be reported on the transplant recipient's claim. They would be held, aggregated together, and reported with revenue code 815. Remember that it's crucial to capture and report all actual donor search and cell acquisition charges for allogeneic stem cell transplants because of the cost reimbursement that is available from Medicare.
Additionally, if you have payers, such as Medicare Advantage or Medicaid, that base payments off MS-DRG, then you are likely getting underpaid for your allogeneic stem cell transplant cases (unless they have made an adjustment). Medicare has removed donor search and cell acquisition costs from MS-DRG 014 because it provides cost reimbursement for those; therefore, the relative weight/payment for MS-DRG 014 has decreased. So, any payer that bases its payment off Medicare rates must address how it will pay providers for donor search and cell acquisition.
Editor’s note: This question was posted in the Billing and Claims section of the NAHRI Forums and answered by NAHRI Advisory Board member Jugna Shah, MPH, CHRI, president of Nimitt Consulting Inc., in Spicer, Minnesota. See more NAHRI resources on transplant coding, billing, and reimbursement here.