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Tip: Report drug administration codes properly

APCs Weekly Monitor, January 28, 2011

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Medicare recognizes the 2011 CPT® Manual’s drug administration codes, and hospitals should use them in accordance with their definitions and the documentation for the services they render.

Because drug administration codes are time-based, nurses and physicians must document information to support the codes they report. Time-based administration services require start and stop times to accurately reflect total time.

Depending on other services rendered during an encounter, payers sometimes consider drug administration services an integral part of the other service.

For example, administration of pain medication following a procedure is an integral part of the procedure and not separately reportable. Providers must follow these coding rules when assigning codes for an encounter. If drug administration can’t be coded separately because it’s considered integral to another service, the charge representing the cost of the services should be reflected on the claim. Do this by including the cost/charge for the other service or by reporting a separate line without the drug administration HCPCS code.

Not reporting the HCPCS code ensures that the charge/cost is reflected for future rate-setting and that no separate payment is made for a service paid for as part of another service.

This tip was adapted from Coding Q&A in the February issue of Briefings on APCs.

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