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No separate charge for surgery-related IV

APCs Weekly Monitor, April 5, 2004

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QUESTION: I am looking for specific regulation to clarify whether intraoperative IV antibiotics are separately payable. For example, are these drugs payable for a patient having vascular surgery?

ANSWER: Until Medicare publishes guidelines regarding this issue, you'll have to go to your fiscal intermediary (FI) for instructions. Below is an example published by Administar regarding this issue.

Amphotericin B, 50 mg is ordered pre-operatively for a patient with a known history of fungal sinus infections. The patient is having outpatient sinus surgery. The drug is given in two separate administrations of 25 mg each, immediately pre-op.

Answer: Bill as follows: 636 J0286-Amphotercin B, 50mg

If a medication is given because of surgery and is specific to the patient, the administration charge is considered part of the procedure charge. The Amphotericin would not be given if it was not for the surgery, and as such, is considered part of the patient's preoperative needs. The need for the drug is specific to the patient, and the need for the drug is specific to the surgery. Therefore, a separate infusion charge for the Amphotericin is not allowed. The infusion is covered in the operating room charges, so do not bill Q0081.

According to the Federal Register's Proposed 2004 Rules, you may not bill Q0081 when it is an integral part of another procedure. In those cases, the charge for the procedure should reflect the costs of the infusion therapy, either as part of the charge for the HCPCS code or as a revenue code charge (e.g., hydration or drug administration during a surgical procedure performed under general anesthesia).

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