Reminder: Follow these guidelines when billing medical drugs that haven’t been purchased

Some health care providers have questioned what to do when billing certain medical drugs that were administered by a medical professional but supplied by our specialty pharmacy.

Here are guidelines to follow in professional and hospital settings:

• When professional providers administer a drug they didn’t purchase, they should bill for the administration code only and not include the drug or NDC code on the claim.
• When professional providers administer a medical drug that was purchased, notes should be documented and a copy of the purchase order included in the member’s chart.
• Identical NDC codes billed within 14 days of a specialty pharmacy claim will be recovered and the provider will need proof of purchase to have the claim repaid.

• When a hospital administers a drug in an outpatient setting that isn’t purchased by the hospital, the hospital should bill for the administration. However, the hospital should include the revenue code and corresponding procedure code for the medical drug with total charges of $.01.

For more information, see the May 2016 and July 2016 Record articles.