Health Information Management

Tip: Report drugs with HCPCS code, revenue code 636

APCs Insider, June 24, 2011

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

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.



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular