Part B NY News: Drug Coding and Radiopharmaceutical Reporting Reminder

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Drug Coding and Radiopharmaceutical Reporting Reminder

This article provides requirements for coding claims containing drugs and radiopharmaceuticals.

Drugs Assigned to a HCPCS Code
When reporting a drug assigned to a HCPCS code, follow the instructions below:

Report the HCPCS code assigned to the drug administered
In the Quantity Billed field, enter multiples of the units shown on the Average Sales Price (ASP) Fee Schedule.

For example: If the ASP Fee Schedule code description is 100 mg, and 500 mg are administered, five (5) units should be reported.

The Web address for the Medicare Part B Drugs Average Sales Price (ASP) Information Resource is http://www.cms.hhs.gov/providers/drugs/asp.asp.

Not Otherwise Classified (NOC) Drugs
When reporting an NOC drug, follow the instructions below:

Enter the name of the drug, National Drug Code (NDC) number and dosage administered in the claim narrative.
Enter the most appropriate NOC code in the Procedure Code field
Enter a quantity of one (1) in the Quantity Billed field

For example:	150 mg were administered to the patient.
	You would enter the name of the drug, the NDC number and “150 mg” in the claim narrative.
	In the Quantity Billed field, you would enter a one (1).

Radiopharmaceuticals/Radionuclides
When reporting Radiopharmaceuticals/Radionuclides, follow the instructions below:

Enter the Total Acquisition Cost in the claim narrative.
Enter a quantity of one (1) in the Quantity Billed field.

NOTE: When reporting NOC Radiopharmaceutical procedure codes A4641 and A9999, enter the name of the radioactive drug and the Total Acquisition Cost in the claim narrative. Enter a quantity of one (1) in the Quantity Billed field.

Posted: 12/09/2005