E/M Coding Alert - 2018 Issue 7
Reader Question: Bill Drug Codes to Facility Outpatient Hospital Setting
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Article Overview
This short Q&A article explains how billing responsibility for a drug can differ between an office setting and a hospital outpatient facility setting. It is useful for physicians, facility coders, and outpatient billing staff who need a general understanding of drug billing in facility-based services and a referenced modifier that may be relevant in some situations. The article also points readers to an external CMS resource for additional background.
Why This Topic Matters
Correctly distinguishing professional and facility billing responsibility helps avoid duplicate billing and supports compliant outpatient claim submission. The article is relevant to coding and billing teams that work with drug administration in hospital outpatient environments.
What You Will Learn
- How the article frames billing responsibility for a drug in a facility outpatient setting
- Which general setting distinctions the article discusses
- Why a modifier may be relevant in some drug billing situations
- Where the article directs readers for additional CMS information
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Hospital outpatient departments
- Facility revenue cycle teams
Codes Discussed
Modifiers Discussed
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