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B&O suppositories as self-administered drugs

APCs Weekly Monitor, November 21, 2008

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Q. In an acute care hospital setting, should we bill a belladonna and opium (B&O) suppository with a self administered 637 revenue code or with a 250 revenue code?  

A. The direct answer is that, in general, you should consider a B&O suppository to be self-administered, and bill it under revenue code 637 with HCPCS-Modifier A9270-GY (Non-covered item or service, statutorily excluded). However, check with your Medicare contractor to verify specific billing instructions.

To fully understand CMS thinking on self-administered drugs, read CMS Benefit Policy Manual 100-02, Section 50 – Drugs and Biologicals.

In this section, CMS states

The term "administered" refers only to the physical process by which the drug enters the patient’s body. It does not refer to whether the process is supervised by a medical professional (for example, to observe proper technique or side-effects of the drug). Only injectable (including intravenous) drugs are eligible for inclusion under the "incident to" benefit. Other routes of administration including, but not limited to, oral drugs, suppositories, topical medications are all considered to be usually self-administered by the patient.

The section discusses situations in which injectable drugs might be self-administered, or in which oral drugs might not be self-administered.

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