AHA Coding Clinic® for HCPCS - 2006 Quarter 4
Changes for the reporting of drug administration
CMS is adopting the full set of CPT codes for the reporting of drug administration services in CY 2007 for use under the hospital outpatient prospective payment system (OPPS). According to CMS’ OPPS final rule published November 24, 2006, the current list of C-codes currently being used to report drug administration services under the OPPS will be discontinued, effective December 31, 2006. Hospitals providing outpatient services under the OPPS will be reporting the full range of CPT codes for drug administration services provided on or after January 1, 2007. During calendar year (CY) 2006, the Centers for Medicare &...
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Article Overview
This article explains CMS updates affecting how hospital outpatient drug administration services were reported under the OPPS beginning in 2007. It covers the phaseout of a set of HCPCS C-codes, the adoption of CPT drug administration codes, and a descriptor change noted by CMS in connection with those reporting updates. The piece is relevant to hospital outpatient coding staff, billing teams, and reimbursement professionals who track CMS OPPS policy changes and code-set transitions.
Why This Topic Matters
Code-set transitions under the OPPS can affect hospital outpatient reporting workflows, charge capture, and compliance. Understanding which codes were being replaced, which were retained, and which CPT reporting conventions CMS emphasized helps coding and billing teams stay aligned with current policy changes.
Article Sections
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CMS OPPS reporting changes for drug administration
Overview of CMS policy changes affecting outpatient drug administration reporting and the timing of the transition to a different code set. The section places the update in the context of the 2007 OPPS reporting environment.
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HCPCS C-codes used for drug administration services
Discussion of the HCPCS code family referenced in connection with prior OPPS reporting for drug administration services. The section identifies the codes affected by the change and notes the retained code discussed by CMS.
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Newly recognized CPT codes for 2007
Summary of the CPT reporting set CMS noted for drug administration services furnished on or after January 1, 2007. The section presents the broader code group associated with the OPPS transition.
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CMS reporting reminder and descriptor update
CMS reminder about reporting drug administration services consistently with CPT guidance and correct coding principles. The section also notes a descriptor update affecting certain infusion service codes.
What You Will Learn
- How CMS changed OPPS reporting for drug administration services in 2007
- Which code families were part of the transition for hospital outpatient reporting
- What general types of CPT reporting updates CMS highlighted for infusion and injection services
- Why descriptor revisions and code-set alignment matter for outpatient billing workflows
Who Should Read This
- Hospital outpatient coders
- Billing and reimbursement staff
- Revenue cycle teams
- Compliance professionals
- Health system coding managers
Codes Discussed
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