Drug administration 'rejection relief' coming to hospitals
Health Care Auditing Strategies, August 1, 2006
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Expect modifier -59 claims processing help from CMS, FIs, according to new article
When CMS' correct coding initiative (CCI) edits for drug administration services took effect April 1, hospitals nationwide were plunged into a sea of rejected injection/infusion line items. But relief is on the way.
Effective for claims of service on or after April 1 through June 30, FIs will add modifier -59 "where appropriate" to ensure that both codes in the six pairs affected by the change (see the table "Drug admin pairs not subject to -59" at right) will be paid separately. FIs' claims processing systems will automatically append modifier -59 to the code in column two of the pair when reported together.
FIs are supposed to notify each provider individually as to when this claims processing change will take effect. Previously, the CCI edits effective April 1 caused line-item rejections for the six affected code pairs, unless providers appended modifier -59 themselves.
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