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You Be the Expert: Blood Transfusion

Test your knowledge.  Determine what you would do in this situation before looking at the box below for the answer.

Question: Are any E/M codes associated with blood transfusion (36430), or does this code include the history and physical, etc., that occur when an outpatient comes in only for a blood transfusion?

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Answer: There are no specific E/M codes for blood transfusions. Each case is unique. If, during a patient's visit, the need for a transfusion is indicated, then it is appropriate to code an E/M level with 36430 and add modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the E/M code. If modifier -25 is not used, just the 36430 will be paid.
 
The specific E/M code you use will be based on the documentation provided in the record. If the only reason for the patient's visit is the blood transfusion, then the supplies, prep and administration, and the dressings on discharge are included in 36430 and no E/M is appropriate. Usually, this type of process does not involve the traditional history and exam of a regular visit. If some assessment is performed that could justify an E/M code beyond the administration of the blood, then the same guidelines on adding an E/M apply. This assessment could be brief and may not require the presence of the physician.
 
Outpatient code 99211 (evaluation and management of an established patient, that may not require the presence of a physician) for an established patient may be appropriate here, especially if nursing education or training was provided.


- Published on 2001-08-01