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Outpatient Facility Coding Alert

Reader Question:

Bill Drug Codes to Facility Outpatient Hospital Setting

Question: Our physician performed a Myobloc injection in order to treat a patient with gastroparesis. Since this was performed in a hospital outpatient surgery center, can the physician bill out for the drug?

Massachusetts Subscriber

Answer: In this situation, the facility will bill J0587 (Injection, rimabotulinumtoxinb B, 100 units). The physician may only bill for the drug if she performs the procedure in an office setting. Whenever a procedure involving the use of a drug is performed in a facility, such as a hospital outpatient center, the facility will bill for the drug.

Remember: In some instances, modifier JW (Drug amount discarded/not administered to any patient) may apply. For more information, refer to: www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/JW-Modifier-FAQs.pdf.