Health Information Management

Q&A: Updates to drugs with pass-through status

APCs Insider, July 25, 2014

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Q: Did any new drugs receive pass-through status July 1?
 
A: Yes, CMS granted three drugs and biologicals pass-through status beginning July 1, 2014. These are listed in Transmittal 2971, along with the APC and status indicator assignments:
  • C9022, injection, elosulfase alfa, 1 mg
  • C9134, Factor XIII (antihemophilic factor, recombinant), Tretten, per 10 i.u.
  • J1446, injection, tbo-filgrastim, 5 micrograms
HCPCS codes C9022 and C9134 are new codes for July 1.
Also consider these additional HCPCS code changes t. Changes effective July 1 include:
  • New code Q9970 (injection, ferric carboxymaltose, 1 mg) replaces HCPCS code C9441, which is being deleted.
  • New code Q9974 (injection, morphine sulfate, preservative-free for epidural or Intrathecal use, 10 mg) replaces J2275. The status indicator for J2275 changes to E (not payable by Medicare).
  • HCPCS code J2271 (injection, morphine sulfate, 100 mg) has a status indicator change, from N (packaged payment) to E. This is effective for any outpatient bill type.
Be sure that your chargemaster is updated with these codes. In addition, it's a good time to validate that the correct number of units are being reported based on the HCPCs code description. 
 
Audits continue to reveal under-reporting of units of drugs based on what is ordered, documented, and administered, which causes an underpayment to the facility. It is very important to validate the correct numbers of units are reported based on the documentation in the record.
 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.



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