Wiki Pharm trial admin help

[Mrshonda11]

A pharm trial drug is administered as a chemo push and zofran is also given. The trial drug admin gets sent to the trial. The zofran and admin will go to insurance. The pharm drug should be given the initial but if that is done then the zofran admin will be denied because it is on a claim by itself as a subsequent admin. Help! Suggestions?

 

[hmassimino]

We just came across this today with MCR. We were told to rebill with the subsequent code as the initial because MCR cannot see the study drug and admin. Sounds wrong to me, but our supervisor agreed with MCR.

 

[alannae]

So the drug trial pays for the admin of the chemo drug?

This isn't the same situation but what we do if we administer a drug that we don't supply is bill the drug for $.01 to provide the info of the drug given without charging for it. (We do $.01 instead of $0.00 because our software doesn't allow for $0.00). We have done this for our previous Medicare contractor and now with Novitas as well as other insurance companies.

Perhaps the same thing could be done? Bill the 96409 or 96413 for $.01 so that there is an initial code on the claim? That way you are providing them with the information and codes that they need to make sense of what was done but you will not be getting paid for it.