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IP PCS Codes

Duang Posted Thu 30th of April, 2020 09:55:57 AM
This is regarding a PCS code representing the device or drug that links to box 74 on the UB04. Example PCS codes are "XW033C3" or "ZW033H4" or "XW033N5"...If a patient has 3 drugs on 3 different dates, do they use one PCS code for each treatment/day or should it be one combined code that covers all 3 days? Does that impact the payment? Does the coder usually code the PCS code for each day that the drug is administered?
Duang Posted Fri 01st of May, 2020 10:00:28 AM
Also, more info! If the same drug were administered for 3 different dates, would you code it as one "occurrence" or 3 "occurrences"? The coder only reported one PCS code for the 3 different days, so we are trying to see if the hospital lost revenue due to the coder only billing/coding for one day/occurrence, instead of 3 days/occurrences? In general, is there different coding between the same drug and different drugs? Thank you!
SuperCoder Answered Mon 04th of May, 2020 01:45:35 AM

Hi,

We have forwarded the query to our PCS experts. We will respond to your query soon.

Thanks for your patience. 

Duang Posted Mon 04th of May, 2020 09:54:07 AM
No problem. Thank you!
SuperCoder Answered Tue 05th of May, 2020 01:26:07 AM

Hi Duang,

 

If the administration started and ended on the same date, then yes, you would code it as three different occurrences. As for the question “in general, is there different coding between the same drug and different drugs”, this can depend on everything from type of drug to the hospital policy on what they are capturing. Some drugs are captured via chargemaster and others are included in the respective prospective payment system (PPS) rates. Others like a chimeric antigen receptor T-cell immunotherapy can be reported to garner the New Technology add-on payment which helps to recuperate the excessive cost of the drug. Overall, it really depends on the drug, method of administration (i.e. a separate injection each day vs infusion that could span over a midnight), and hospital policy.

 

Thanks!

Duang Posted Tue 05th of May, 2020 10:48:40 AM
Thanks for your answer. How do you code the leukemia drug that is given once a day for three different days?
SuperCoder Answered Wed 06th of May, 2020 01:24:02 AM

Hi Duang,

 

Again it would depend on the actual brand/name of the drug and hospital policy, but from a coding standpoint you could potentially capture each administration. Coding would also depend on if the drug was administered via injection or infusion. Occasionally infusions are consider reportable whereas injections are not, due to the increase in materials and monitoring. I recommend you contact billing department and compliance department to review policies or develop policies.

 

Thanks!

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