AHA Coding Clinic® for HCPCS - 2008 Quarter 3; FOR your INFORMATION
Reporting drugs and biologicals when used as implantable devices
Under the OPPS, hospitals typically are not to separately report drug and biological HCPCS codes. Additionally, hospitals are provided a packaged APC payment for surgical procedures that includes the costs of implantable devices without pass-through status. The exception to this rule is when a drug or biological with pass-through status is used as an implantable device during a surgical procedure. In these instances, hospitals have the following three options: Include the charges for these items in their charge for the procedure Report the charge on an uncoded revenue center line, or Report the charge under a device HCPCS code...
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Article Overview
This premium article addresses outpatient hospital billing under the OPPS for drugs and biologicals used in implantable device situations. It focuses on the general packaging of these costs, the exception for pass-through status, and the broad reporting approaches hospitals may consider. The content is relevant to hospital coders, billing staff, and revenue cycle professionals who work with outpatient surgery and device-related reporting.
Why This Topic Matters
Understanding this topic helps hospitals recognize when drug and biological costs are packaged versus when a special reporting pathway applies. It is important for accurate outpatient claims processing and for keeping device-related cost data available for future payment setting.
What You Will Learn
- How OPPS generally handles drug and biological reporting in hospital outpatient settings
- What broad exception category is discussed for implantable device use
- Which general reporting approaches are described for these situations
- Why these reporting choices matter for outpatient payment and cost accumulation
Who Should Read This
- Hospital outpatient coders
- Billing and reimbursement staff
- Revenue cycle professionals
- Compliance and charge capture teams
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