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There have been questions regarding whether it is appropriate to bill CPT codes for IV push injection when given in conjunction with a blood transfusion - particularly since the IV push injection requires a 59 modifier when billed on the same outpatient date of service as the blood transfusion, CPT code 36415, representing a separate and distinct service.

We contacted National Correct Coding Initiative and received confirmation that it is appropriate to bill IV push injections in this scenario for the administration of drugs administered in conjunction with the blood transfusion, including but not limited to Benadryl, Lasix, Solumedrol. the drugs must be ordered by the physician and medically necessary.

It is also appropriate to assign modifier 59 to the IV push injections to verify the codes are not being reported for the actual administration of the blood.

CMS provides clear guidance on billing for frozen/thawed blood products.  Providers should bill the most specific HCPCS code that describes the blood product in addition to the CPT code for the transfusion.  If the blood product HCPCS code description includes “frozen” in the description, it would not be appropriate to also bill additional CPT codes for freezing and/or thawing since charges for freezing and thawing should be included in the charge for the product.  If there is not a specific HCPCS code for the frozen blood product, then the provider should bill the appropriate HCPCS code for the blood product plus the CPT codes for freezing and/or thawing.  Also, if a product is frozen and/or thawed in preparation for a transfusion, but the patient does not receive the transfusion, the provider may bill for the freezing and/or thawing services provided.  Please note that for frozen plasma HCPCS codes P9017, P9023, P9059 and P9060; cryoprecipitate HCPCS codes P9012 and P9044; and frozen blood/RBC HCPCS codes P9039, P9054, and P9057 freezing and thawing codes are not separately billable.

This information can be found in Chapter 4 of the Medicare Claims Processing Manual, section 231.6 including a detailed list of all blood/blood product codes with freezing/thawing billing instructions. Link to the Claims Processing Manual Chapter 4:
http://www.cms.hhs.gov/manuals/downloads/clm104c04.pdf

The same billing guidelines apply to blood and blood products regarding irradiation of blood (§231.5) and autologous processing (§231.3).