Pharmacy Question for the Week of July 22, 2019

Pharmacy Compliance Question of the Week


Can you provide details on the RAC audit for prophylactic and diagnostic injections?


The audit issue name is “0161-Therapeutic, Prophylactic, and Diagnostic Injections and Infusions: Documentation Requirements.” According to the Centers for Medicare & Medicaid Services, “documentation will be reviewed to determine if correct billing, coding, and medical necessity guidelines for therapeutic, prophylactic, and diagnostic injections and infusions were met.” The audit was approved on June 4, 2019.