Health Information Management

Q/A: Select correct revenue code for packaged drugs

APCs Insider, February 5, 2010

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Q: What is the best revenue code to use to bill packaged drugs? Does any guidance support the use of one revenue code instead of another?
 
A: You may report packaged drugs with pharmacy revenue code 0250 or 0636. Note that many hospital chargemasters are configured to not require detailed HCPCS coding for revenue code 0250. CMS and other third-party payers accept UB04 claims with no HCPCS code and with all charges totaled and multiple units reported on one line for revenue code 0250. Conversely, CMS and most other payers require line item detail for revenue code 0636. This means that providers should report the individual HCPCS code with the correct units for that code as a separate line itemin effect, one line for each drug.
 
CMS determines for each OPPS year whether a drug has separate or packaged OPPS payment. The Outpatient Code Editor will pay packaged drug as such when providers bill them with the appropriate HCPCS code and units. However, CMS loses important claim detail when hospitals report drugs with revenue code 0250 and no HCPCS detail. CMS provided the following guidance in the CY 2010 final rule:
 
While we do not require hospitals to use revenue code 0636….when billing for drugs and biological that have HCPCS codes, whether they are separately payable or packaged, we believe that a practice of billing all drugs and biologicals with HCPCS codes under revenue code 0636 would be consistent with NUBC billing guidelines and would provide us with the most complete and detailed information for rate setting.” “OPPS rate setting is best served when hospitals report charges for all items and serviced that have HCPCS codes under those HCPCS codes, whether or not payment for the items and services is packaged or not.



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