tci Outpatient Facility Coding Alert - 2015 Issue 2

Part D Coverage: Clear Your Confusion on Self Administered Drug by Focussing on Your Facility's Guidelines

Understand 5 factors related to how the drugs were used. Coding for self-administered drugs is always a challenge, as the big question remains whether it shall be covered by Medicare Part B since self-administered drugs can get approved only in certain situations. These parameters make it very important to focus on how the drug was used when trying to code. Start by Understanding What Medicare Covers Medicare covers self-administered drugs given in the hospital inpatient setting and in certain circumstances, those provided on an outpatient basis, according to Sarah Goodman, MBA, CHCAF, CPC-H, CCP, FCS, president of the consulting...

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