Pharmacy Question for the Week of July 16, 2018

Pharmacy Compliance Question of the Week

Question:

What OPPS billing guidelines should be followed when commercially available products are mixed together to facilitate their concurrent administration?

Answer:

Under the outpatient prospective payment system (OPPS), if commercially available products are being mixed together to facilitate their concurrent administration, the hospital should report (by HCPCS code) the quantity of each product used in the patient’s care. Alternatively, if the hospital is compounding drugs that are not a mixture of commercially available products, but are a different product that has no applicable HCPCS code, then the hospital should report an appropriate unlisted drug code (J9999 or J3490).

In these situations, it is not appropriate to bill HCPCS code C9399 (unclassified drug or biological), which is for new drugs and biologicals approved by the Food & Drug Administration but a specific HCPCS code has not been assigned yet.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.