Health Information Management

Tip: Report drugs with HCPCS code, revenue code 636

APCs Insider, June 24, 2011

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Many facilities report packaged drugs under revenue code 250 (pharmacy) regardless of whether an applicable HCPCS code exists. Facilities report separately payable HCPCS codes under revenue code 636 (drugs with detailed coding) to ensure that they receive reimbursement.

CMS notes in the 2010 OPPS final rule that HCPCS codes reported under revenue code 250 are "lost" during claims processing procedures and therefore not available for rate-setting consideration under OPPS. CMS uses HCPCS-coded drugs to establish the percentage of payment added to the average sales price to cover pharmacy overhead and expenses. CMS includes drugs reported under revenue code 636 in this calculation.

CMS recommends that facility providers ¬report all drugs with a HCPCS code under revenue code 636 to better capture actual pharmacy overhead cost through claims data. HCPCS codes need not be reimbursed separately to be reported under revenue code 636. Reporting in this manner is CMS' only mechanism to calculate payments for subsequent calendar years.

The tip is adapted from “This Month's Coding Q&A” in the June issue of Briefings on APCs.

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