AHA Coding Clinic® for HCPCS - 2013 Issue 4
Self-administered drugs in the outpatient setting
In the second quarter 2013 issue of Coding Clinic for HCPCS, we published an article reviewing the reporting of drugs and biologicals. One aspect not covered in that article, but of importance to coders, is how to report self-administered drugs in the outpatient setting. We often receive questions regarding if either the drug itself or the administration of the drug is reportable under the Outpatient Prospective Payment System (OPPS). The answer is generally no, but sometimes, yes. Therefore, we decided it might be a good idea to review the general guidelines with respect to self-administered drugs. The term &ldquo...
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Article Overview
This article explains the Coding Clinic for HCPCS guidance on self-administered drugs in the outpatient setting. It is aimed at hospital coders, billing staff, and revenue cycle professionals who need to understand when drugs or their administration may be considered reportable under OPPS, and when they are treated as packaged supplies. The discussion includes broad categories of self-administered medications, examples of drugs considered supplies in procedural settings, examples that are not integral to a procedure, and a Q&A section addressing outpatient administration reporting.
Why This Topic Matters
Hospitals and outpatient departments need clear guidance to avoid incorrect billing of drugs and drug administration services under OPPS. This topic affects compliance, claim accuracy, and whether certain medication-related services are separately reportable or bundled with procedures.
Article Sections
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Introduction
Introduces the topic of self-administered drugs in the outpatient setting and frames the reporting questions addressed in the article. It also identifies the general payment context discussed in the guidance.
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General guidance on self-administered drugs
Summarizes the broad categories of medications and routes of administration discussed as self-administered in the outpatient setting. The section also notes the general reporting approach and the types of exceptions covered in the article.
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Drugs treated as supplies
Describes examples of medications discussed as being part of a procedure rather than separately reportable. The section focuses on the types of procedural settings and the kinds of hospital services referenced in the guidance.
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Drugs not directly related or integral to a procedure
Reviews examples where medications are discussed as not being packaged with a procedure. It distinguishes these situations from the supply examples and summarizes the broad circumstances involved.
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Questions and answers
Presents a practical Q&A portion addressing outpatient reporting concerns for self-administered drugs. The section is intended to clarify how the guidance is applied in a specific hospital setting.
What You Will Learn
- How self-administered drugs are discussed in the outpatient setting
- The general OPPS reporting framework for medication-related services
- How the article distinguishes packaged supplies from separately considered drugs
- The role of hospital guidance and Coding Clinic examples in outpatient reporting
- The type of practical questions hospitals raise about administration reporting
Who Should Read This
- Hospital coders
- Outpatient billing staff
- Revenue cycle professionals
- Compliance staff
- Health information management professionals
Codes Discussed
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