Make determinations for self-administered drugs: Plan for best practices
APCs Weekly Monitor, November 14, 2008
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In this second article of a two-part series. William L. Malm, ND, RN, partner, Health Revenue Integrity Services in
Always remember that the problem of self-administered medications is an outpatient phenomenon, says Malm. For outpatient self-administered medications, one of two revenue codes may be appropriate based on the delivery:
- 637, if the drug isn’t integral to a procedure
- 250, the packaged revenue center, if the drug is integral to a procedure performed while the patient is in outpatient or observation status
All medications given as an inpatient service are covered and generally use revenue code 025x, representing general pharmacy.
“The key is to use the appropriate revenue code to get the claim to process correctly,” says Malm. It may also be necessary to apply a HCPCS code for further clarification.
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