decisionhealth Newsletters, Coder Pink Sheets - 2003 Issue 9 (September)
Medicare: OK to bill 90780 for drugs from other sources
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Article Overview
This article addresses a Medicare update on billing for administration of covered drugs when the medication is brought in from another source rather than furnished by the practice. It is aimed at physicians, coders, and billing staff, especially in office-based settings such as gastroenterology, and it highlights the broader documentation and evaluation-and-management issues that can arise when only drug administration is performed. The piece references a Medicare transmittal and uses practical office scenarios to frame the guidance without replacing the underlying policy detail.
Why This Topic Matters
It helps practices understand when administration services may be reported separately and why routine injection-only encounters do not automatically support an evaluation-and-management visit.
Article Sections
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Medicare billing question about administering patient-supplied drugs
Introduces an office scenario involving administration of medication brought by the patient and asks whether related services may be billed.
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Medicare guidance on covered drug administration
Summarizes the Medicare policy update and notes the date on which the revised guidance took effect. It also identifies the transmittal cited in the article.
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Evaluation and management coding considerations
Discusses whether a low-level office visit code is supported in an injection-only encounter and references staff commentary on assessment requirements.
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Gastroenterology example involving Sandostatin LAR
Provides a specialty-specific example from gastroenterology to illustrate the type of medication administration scenario addressed by the policy.
What You Will Learn
- How Medicare addresses billing for administration of certain covered drugs supplied from outside the practice
- Why injection-only encounters may not support routine office visit reporting
- How the article frames the documentation and assessment context for these services
- How a gastroenterology practice example relates to the Medicare guidance
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Office managers
- Gastroenterology practices
Codes Discussed
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