AHA Coding Clinic® for HCPCS - 2010 Quarter 3; FOR your INFORMATION
A Reminder From CMS Regarding Billing for Drugs, Biologicals, and Radiopharmaceuticals
When reporting drugs, biologicals, and radiopharmaceuticals, hospitals are strongly urged to utilize the correct HCPCS codes for the items used regardless of whether the items are paid separately or packaged. Hospitals must make certain that the units of service of the HCPCS code(s) reported are consistent with the quantity of drug, biological, or radiopharmaceutical utilized in the care of the patient. Under the OPPS if two or more drugs or biologicals are mixed together to facilitate administration, the correct HCPCS codes should be reported separately for each product used in the care of the patient. The mixing together of...
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Article Overview
This article explains CMS guidance for hospitals on reporting drugs, biologicals, and radiopharmaceuticals using HCPCS coding. It is relevant to outpatient hospital billing, charge capture, and coding compliance teams that work with separately paid and packaged items, mixed products, and compounded products. The discussion focuses on the general categories of coding guidance and the circumstances under which hospitals are directed to use unclassified or unlisted HCPCS options.
Why This Topic Matters
Accurate reporting of these items affects claims integrity and compliance in hospital outpatient billing. The article helps readers understand the scope of CMS reminders affecting HCPCS reporting for product use, mixed administrations, and products without a specific code.
What You Will Learn
- How CMS frames hospital reporting of drugs, biologicals, and radiopharmaceuticals under HCPCS
- What broad categories of product situations are addressed in the reminder
- How the article approaches mixed products and compounded products at a high level
- Which kinds of hospital billing scenarios are discussed in relation to HCPCS reporting
Who Should Read This
- Hospital outpatient coders
- Billing staff
- Revenue cycle teams
- Coding compliance professionals
- Charge capture specialists
Codes Discussed
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