That's the direction I was going in, too. Thanks for the affirmation.
Here is a description I found in a newsletter from HCPro - in case anyone else ever sees this term!
"Hyfrecation is actually a really old, outdated term that
a physician may use to describe the cautery (either
chemical or electrical) of tissue. It is not synonymous
with tissue destruction.
This term is actually so old that it isn't listed in
any of the medical dictionaries I own. Fortunately, I
remembered a device that a physician I worked for
30 years ago had. The device, which he referred to as
a “hyfrecator,” was a small black box with leads and
received a credit for in the amount of the cost of the
replaced device.
However, it is noted that there is no OCE edit
in place that will “return to provider” the claim if a
drug administration code is reported without a corresponding
drug product code.
Note that in cases where a patient is on a drug
trial, the medication costs are borne by the manufacturer
and not the payer.
Based upon that guidance, we would suggest you
only bill the payer for the administration, and shift the
cost of the drug back to the manufacturer of the drug.
CMS' Medicare Benefit Policy Manual 100-02 indirectly
addresses this issue. Section 30, “Drugs and Biologicals,”
in Chapter 6, “Hospital Services Covered Under Part B,”
refers the reader to Chapter 15, “Covered Medical and
Other Health Services,” for a description of conditions
for coverage of drugs and biologicals.
In Chapter 15, section 60.1, CMS indicates the
following:
To be covered, supplies including drugs and biologicals,
must represent an expense to the physician or legal entity
billing for the services or supplies. For example, where a
patient purchases a drug and the physician administers it,
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. Therefore, administration
of the drug is payable if the drug would have been
covered if the physician purchased it.
National Government Services (formally Admini-
Star Federal), a CMS contracted Medicare agent, has
also issued a memorandum titled “Billing Administration
Code without a Drug Line Item” in February
that reflects these instructions.
This memorandum addresses drugs obtained
through manufacturer's patient assistance programs.
Based on these references, it is appropriate to submit
the chemotherapy administration code without a corresponding
drug line item.
Consult your FI or Medicare administrative contractor
for further instruction about this issue.
Injections/infusions < continued from p. 5
Integumentary system, surgery
a wand-like apparatus that conducted an electrical
signal that the physician used to burn a wound to
stop the bleeding, or to destroy warts and lesions.
Physicians may use this device to seal the edges
of a wound or lesion that is oozing or bleeding. Consider
this part of the primary procedure (excision and
removal), and do not code it separately."
Thanks for your help!
Lin
CPC
