Author Topic: Injections for Hospitals  (Read 1213 times)

Scott

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Injections for Hospitals
« on: May 20, 2016, 12:01:39 PM »
Hello. I was wondering if anyone has experience billing injections for hospitals in New York.  We bill injections for doctors, but have recently been asked about hospitals.  Would we just bill the appropriate J code on a UB04 form?

Michele

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Re: Injections for Hospitals
« Reply #1 on: May 20, 2016, 01:07:07 PM »
Are you asking about billing strictly injection fees?  There is no other service?  I have not heard of that before so I just want to make sure I know what you're checking on.
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Scott

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Re: Injections for Hospitals
« Reply #2 on: May 23, 2016, 02:35:59 PM »
Hi Michele.  Our experience has been billing for physicians who administer injections (B12, cortisone as examples) in their practice - office setting.  These physicians are pharmacy credentialed so we normally adjudicate the drug itself (not necessarily the administration of the drug) through their pharmacy benefit contract, as opposed to through their medical insurance contract.  We've been presented with an opportunity to do the same for a hospital in NY. However, since hospitals are required to have/utilize true pharmacies, I believe we would now be required to bill the injection through the hospital's medical contract using either their normal medical billing clearinghouse or on a paper form, which I think would be the UB04, using the appropriate J-code, NDC, and AWP.  I'm not 100% sure I'm explaining it correctly, so I apologize ahead of time.

Michele

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Re: Injections for Hospitals
« Reply #3 on: May 23, 2016, 07:49:57 PM »
You are probably explaining it correctly, it's just not something I've ever come across.  But if you are billing for the hospital as a facility then I would think it would be on the UB04 form (or electronic version of the UB04) unless the hospital is also set up to bill professional fees.  If you bill on the UB04 you will need to use a Rev code as well.  I think the Rev code you may be looking at is 0636.
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