Pharmacy

For the Week of December 5, 2016

How do we bill for pharmacy supplies?

There are two classifications for supplies: sterile and non-sterile, and a different revenue code must be reported for each group. Nonsterile supplies are assigned to revenue code 271, and sterile supplies are assigned to revenue code 272. There are usually no CPT or HCPCS Level II codes assigned to these revenue codes.

Most drugs are packaged into the outpatient prospective payment system (OPPS) ambulatory payment classification (APC) rate for Medicare patients and are reported with revenue code 250—general pharmacy. Some drugs require specific identification and will be paid separately under the APC system. A drug that has an associated HCPCS Level II “J” code can be reported on the claim form on separate line items with revenue code 636—drug requiring detailed coding. Depending upon the actual J code, additional reimbursement may be realized on the Medi¬care remittance advice.

Each year, when the final OPPS rule is released in November, it is important that facilities have a chargemaster analyst review the drugs and determine if the appropriate HCPCS level II “J” codes are being reported.