IP hospital billing for chemotherapy administration

Is it proper coding to bill Rev. Code 335 (chemo admin) in addition to the Room & Board charges or is RC 335 considered bundled in the R&B?

I have been told by a payer and hospital that RC 335 is just for OP billing, but told by 2 other larger hospitals that it is billable for IP and OPs, and should not be bundled.

Thank you.

Inpatient Billing for Chemotherapy Administration

I think it will depend upon your payer. For Medicare billing, if reporting r/c 335, one should also report r/c 636 & use the corrrect HCPCS II code to describe the drug. R/c 636 is not used on inpatient Medicare claims. Drugs are reported under r/c 250 with no HCPCS code. For outpatient Medicare billing, use r/c 335 & 636.

re: IP billing admin

I recently researched this topic as I just updated my chargemaster presentation. In my research, I came across a number of opinions about billing admin itself in the inpatient setting.

One suggested practice is to build the OPPS infusion logic into the Charge Master & then link the charge code & the appropriate CPT to capture inpatient charges for admin because ICD-9 procedure codes are not detailed enough to capture this data. (using rev code 230)

The thought is that these are not included in the inpatient room rate because they are not routine nursing services as stated in Medicare Provider Reimbursement Manual, Part 1, 2202.3: "Inpatient routine services included in a hospital by the provider in a daily service charge, sometimes referred to as the "room and board" charge. Included in routine services are the regular room, dietary and nursing services, minor medical and surgical services, medical social services, psychiatric social services and the use of certain equipment, & facilities for which a separate charge is not customarily made."

Others feel that these admin charges are **indeed** part of the nursing services that are already included in the room and board charge and should not be charged separately.