Corporate Compliance

Note from Hugh

Medicare Insider, April 1, 2008

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As noted below, last week CMS released the April update to the I/OCE specifications. One change made in the April specifications relates to revenue code 0637 ("Self-administrable drugs"). Although not entirely clear, it appears that I/OCE edit 50 ("Non-covered based on statutory exclusion") will be applied when a charge is reported using revenue code 0637 without a HCPCS code. The effect of edit 50 is to "line item reject" the charge.

This gives rise to an interesting question relating to self-administered drugs that are covered by Medicare in an outpatient hospital setting because they are considered "integral" to an outpatient procedure (see CMS Program Memo A-02-129). There is no assigned HCPCS code for most self-administered drugs. Consequently, it is not clear how hospitals should bill for covered self-administered drugs. One option might be to bill for such drugs using revenue code 0250. In the absence of further clarification from CMS, hospitals should contact their local FI or MAC for guidance on this issue.



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