Facilities can’t bill for separate labs when using point-of-care testing for blood gas analysis

When blood analysis is completed by point-of-care testing in an inpatient hospital setting, Blue Cross Blue Shield of Michigan and Blue Care Network will only pay for the primary charge (per time and date of service) that the blood was analyzed — not for  other associated or separately billed labs. Separate labs should be zero-priced when billed and will be considered a provider write-off.

This policy is effective Jan. 1, 2021, for Blue Cross commercial, Medicare Plus Blue℠, BCN commercial and BCN Advantage℠ members.

Background

Blood gas analysis performed by point-of-care testing, or utilization of a blood gas analyzer, is prescribed by a physician, or a non-physician practitioner, to provide quick laboratory testing using one sample of blood to achieve multiple test results within minutes. It can affect the treatment and management of the patient. This billing policy isn’t intended to affect provider decision-making or patient care. Providers are expected to apply medical judgment when caring for all members.

The following is a list of common point-of-care testing or blood gas analyzer devices that are covered by this billing policy:

• Abbott handheld I-Stat Machine
• epoc^® blood analysis system
• Radiometer

The following is a list of commonly associated, but separately billed labs. These include, but aren’t limited to:

• Electrolytes (for example, sodium, potassium, chloride)
• Lactate/lactic acid
• Ionized calcium
• Creatinine and urea nitrogen
• Hemoglobin and hematocrit
• Glucose