Oncology & Hematology Coding Alert

Question: If one of our Medicare patients purchases a drug and our NPP administers it, may I report this?

North Carolina Subscriber

Answer: You should be able to report this procedure for reimbursement with the appropriate administration code (such as an IV push or infusion).

Here's why: CMS has just issued a revision of its policy for coverage of drugs and biologicals that aren't usually self-administered -- CR 5288 -- with an implementation date of June 2, 2008.

According to the revision of Section 50.3 of the CMS Manual, "When a patient purchases a drug that a physician/NPP or auxiliary staff administers in the office or clinic, the cost of the drug is not covered. However, the administration of the drug, regardless of the source, is a service that represents an expense to the physician/NPP. Therefore, administration of the drug is payable if the drug would have been covered had the physician/NPP furnished it."

More info: You can download CR 5288 from the CMS Web site at http://www.cms.hhs.gov/transmittals/downloads/R87BP.pdf.

But beware: Be sure your practice carefully looks into administering patient-purchased drugs before going this route, considering potential problems such as patients storing the drugs improperly. If you do administer patient-purchased drugs, be sure to follow your payer's specific requirements on listing the drug, strength, dose, NDC number and other key information in the freeform field when you code for administration without a drug charge on the same day.