32211

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Last Modified: 1/6/2012 Location: FL, PR, USVI Business: Part A

32211

The number of blood units on the claim is not equal to the number of blood pints not replaced. Please verify the information billed and submit a new claim, if appropriate.

Effective 10/01/08, the following are blood revenue codes: 0381, 0382.

Resources/tips to avoid or correct this return to provider (RTP) claim

Claims RTP for this reason when the units reported with revenue codes 0381 and/or 0382 do not balance with value codes 37.

Blood and blood products furnished to a patient should be reported using revenue codes 381 (packed red blood cells) and/or 382 (whole blood) along with value code (VC) 37 (blood units furnished). The units reported by each revenue code and/or a combination of these revenue codes should equal to the amount reported with value code 37.

Example:

• Claim billed with revenue code 381, total units 5, should have a value code 37, total units 5.

• RC 381 (5) = VC 37 (5)

• Claim billed with revenue code 381, total units 3, and revenue code 382, total units 2, should have value code 37, total units 5.

• RC 381 (3) + RC 382 (2) = VC 37(5)

The blood deductible (value code 38) is the number of unreplaced deductible units. Therefore, value codes 38 (blood deductible) and 39 (blood units replaced) should equal the amount provided with value code 37 (blood units furnished).

Examples:

• VC 37=3.00, VC 38=2.00, then VC 39 should=1.00 (VC 37-VC 38=VC 39); or

• VC 37=2.00, VC 38=2.00 (VC 39 is not reported if NO units are replaced -- VC 37-VC 38=0); or

• VC 37=3.00, VC 39=3.00 (VC 38 is not reported if ALL units are replaced -- VC 37=VC 39)

Review your claim to ensure the correct amount is being reported with value code 37 and that amount balances with the amounts reported with value codes 38 and/or 39.

Correct and resubmit the claim.

• Direct data entry (DDE)

users can PF9 the claim.