Health Information Management

Tip: Differentiate integral, non-integral self-administered drugs

APCs Insider, March 9, 2012

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In 2002, CMS provided specific guidelines for understanding which self-administered drugs are considered integral to a procedure. Transmittal A-02-129, p. 30, states: "Certain drugs are so integral to a treatment or procedure that the treatment or procedure could not be performed without them." The transmittal provided the following examples of drugs that are integral to performing a procedure:

  • Sedatives administered to patients in the preoperative area being prepared for a procedure
  • Mydriatic drops instilled into the eye to dilate the pupils, anti-inflammatory drops, antibiotic ointments, and ocular hypotensives are administered to a patient immediately before, during, or immediately following an ophthalmic procedure
  • Barium or low-osmolar contrast media used for diagnostic imaging procedures
  • Topical solutions for photodynamic therapy, local anesthetics, and antibiotic ointments

Drugs that are not directly related and integral or packaged supplies include the following, according to 67 FR 66767 and Transmittal A-02-129:

  • Drugs given to a patient for his or her continued use at home. An example is starting a patient on an oral antibiotic in the ED, and then providing a prescription for continuing doses.
  • Drugs related to the procedure or treatment. An example is supplying a patient with aspirin for a headache during chemotherapy treatment.
  • Drugs the patient normally takes at home. An example is a daily supply of insulin or hypertension medication for a patient undergoing outpatient surgery.

The tip is adapted from “Defining ‘integral' tricky for self-administered drugs” in the February issue of Briefings on APCs.

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