Pediatric Coding Alert

Question: We give patients oral Dexamethasone instead of an injection. Only one payer reimburses the supply HCPCS H0033 . Is there another code to use for oral Dexamethasone?


Tennessee Subscriber

Answer: The type of HCPCS level II code that you're using is causing your payment problems. H codes, such as H0033 (Oral medication administration, direct observation), describe alcohol and drug abuse treatment services. State Medicaid agencies that state law mandates "establish separate codes for identifying mental-health services that include alcohol and drug treatment services" use H codes (H0001-H2037), according to the HCPCS Level II manual. Insurers may restrict coverage for these codes to alcohol and drug abuse treatment facilities.

Better option: Code the supply with S0173 (Dexamethasone, oral, 4 mg). Although S codes are temporary national codes, Medicaid, Blue Cross/Blue Shield and other private payers may recognize the non-Medicare codes.

Also:  Include the work of administering the oral medication and monitoring the child for a reaction in the E/M code that you select (for instance, new patient office visit code 99203 or established patient office visit code 99213).