tci Outpatient Facility Coding Alert - 2018 Issue 7

Reader Question: Bill Drug Codes to Facility Outpatient Hospital Setting

Question: Our physician performed a Myobloc injection in order to treat a patient with gastroparesis. Since this was performed in a hospital outpatient surgery center, can the physician bill out for the drug? Massachusetts Subscriber Answer: In this situation, the facility will bill J0587 (Injection, rimabotulinumtoxinb B, 100 units). The physician may only bill for the drug if she performs the procedure in an office setting. Whenever a procedure involving the use of a drug is performed in a facility, such as a hospital outpatient center, the facility will bill for the drug. Remember: In some instances, modifier JW...

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