AHA Coding Clinic® for HCPCS - 2003 Quarter 2; For your information
CMS provides additional instructions for some packaged drugs and biologicals
Under the outpatient prospective payment system (OPPS) most drugs and biologicals are packaged in an ambulatory payment classification (APC) payment for the procedure or service with which the drug was given. The cost of these packaged drugs and biologicals are captured as part of the associated procedure or service When reporting the administration of these packaged drugs and biologicals, facilities have been instructed to utilize the units field to report multiples of the dosage identified by the HCPCS code descriptor. For example, if the amount of the drug administered is less than the amount described by the HCPCS code...
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Article Overview
This article covers CMS outpatient payment and billing guidance for packaged drugs and biologicals, including how hospitals report charges under OPPS when certain drugs, contrast media, or radiopharmaceutical agents are involved. It is relevant to hospital billing staff, outpatient coders, and revenue cycle teams that need to understand CMS instructions, APC packaging, and HCPCS/revenue code reporting conventions. The article also addresses specific CMS instructions referenced in a transmittal and discusses billing treatment for selected procedures and related radiopharmaceutical reporting.
Why This Topic Matters
Correct outpatient billing for packaged drugs and biologicals affects charge capture, claim reporting consistency, and compliance with CMS instructions. Facilities that bill OPPS services need this guidance to understand how packaging, revenue codes, and HCPCS reporting interact in the outpatient setting.
Article Sections
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OPPS packaging overview
Introduces how outpatient payment packaging works under OPPS and how charges for certain drugs and biologicals are captured with the associated service.
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CMS billing instructions for packaged drugs and biologicals
Summarizes CMS guidance for reporting packaged items and related charges in hospital outpatient billing, including references to a program memorandum and transmittal guidance.
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Revenue code and HCPCS reporting guidance
Discusses billing and reporting considerations involving revenue codes and HCPCS reporting for selected drugs, contrast media, and radiopharmaceutical agents.
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Zevalin-related reporting instructions
Covers the article’s discussion of CMS instructions tied to Zevalin and the associated reporting approach for the procedures and related charges.
What You Will Learn
- How OPPS packaging affects outpatient drug and biological charge reporting
- What general CMS billing guidance applies to packaged drugs, contrast media, and radiopharmaceutical agents
- Which hospital billing areas are affected by revenue code and HCPCS reporting instructions
- How the article frames CMS instructions related to a specific radiopharmaceutical product
Who Should Read This
- Hospital outpatient coders
- Facility billing staff
- Revenue cycle professionals
- Compliance staff
- Outpatient reimbursement specialists
Codes Discussed
Code Ranges Discussed
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