New Online Drug Lookup Tool Unveiled

MedLearn Media is launching an online resource believed to be useful for professional coders, charge capture, compliance, and revenue integrity specialists alike.

DrugCode Pro is being marketed as a companion to the MedLearn Infusion and Injection Therapy Services handbook. While this handbook does contain an abbreviated version of the drug code lookup in an Appendix, the table in the handbook is only updated annually, whereas the online tool will be updated on a quarterly basis, keeping industry professionals up-to-date on drug HCPCS information.

The MedLearn team is taking advantage of the multiple data files published quarterly by the Centers for Medicare & Medicaid Services (CMS) to maintain the accuracy of information available in DrugCode Pro.

“In today’s healthcare environment, all providers are experiencing an increase in payer denials for correct drug HCPCS units and drug HCPCS modifier (JW/JZ),” senior healthcare consultant Tiffani Bouchard said. “These denials have increased costs for the providers because the existing staff is either being redirected to spend more time or additional staff are being hired to resolve the drug charge denials. Healthcare industry professionals need an easy-to-use and cost-effective resource to submit their claims correctly the first time.”

Individuals working in the outpatient hospital setting, professional offices/clinics, and freestanding infusion centers will also be interested in learning about the new MedLearn online tool. DrugCode Pro will make it easier for these healthcare professionals to find the correct drug name (generic and brand, where applicable), HCPCS code, and the dose for the code; know the Outpatient Prospective Payment System (OPPS) status indicator for the HCPCS code used in the outpatient hospital setting; see routes of administration (ROA); know which HCPCS requires use of a JW or JZ modifier for professional billing; and identify the drug administration category for a drug HCPCS code and the effective and termination dates.

“I have worked for more than 30 years as a consultant in the healthcare industry,” Bouchard said. “Being a consultant and certified coding professional, I have relied heavily on all types of resources, including use of the CMS Table of Drugs, which is no longer maintained. Because I have spent many years performing chargemaster reviews, coding, charge capture, and billing and claims resolution for pharmacy charging, I have also become more reliant on the use of online resources and tools, through which I can easily search for needed information, rather than thumb through a book. I know speaking from experience that when you do not have the budget for more costly resources, you are more apt to rely on multiple resources to do your work – and this invariably has the potential for information not aligning or being updated at differing intervals. With DrugCode Pro, it contains all the information I need to use to perform charge capture to documentation reviews, coding for drug administration services, compliance billing audits, and claim denials work. “

Bouchard also said that she believes coders and charge capture individuals will find the DrugCode Pro online tool helpful in guiding these individuals to the applicable drug administration code range or codes for use when applying the drug administration CPT® coding hierarchy.

Because the Infusion and Injection Therapy Services handbook already provides coding insight and tips, this tool can be very useful to those individuals who may not have the extensive knowledge to the drug administration category for selecting the most appropriate drug administration CPT/HCPCS code, according to Bouchard.

The lookup tool displays the drug name, the applicable HCPCS code(s), and the standard route of administration abbreviations. Users can also access the Drug Administration Code tab to locate the applicable drug administration code range or code(s) available for use. They will also be able to confirm the billing units for the drug HCPCS code during claim editing.

“Compliance and revenue integrity specialists will find DrugCode Pro very useful in their daily activities,” said Bouchard. “The online tool also contains a drug HCPCS-to-NDC table. Since the hospital or provider claim has to contain the drug NDC, users will be able to confirm the drug HCPCS code is appropriate, as well as be able to reconcile the units being reported.”

DrugCode Pro will also assist in ensuring the correct charge lines are present on the claim when one vial or multiple vials (i.e., with different manufacturer packaging) are used for the drug administration. Users can confirm in the patient medication administration record (MAR) and infusion flowsheets if there was any discard or waste amount for the portion of drug not administered.

Bouchard said using DrugCode Pro will allow professionals to ensure that the drug HCPCS code(s) are appropriate, and the claim contains (or does not contain) the charge line for the amount of drug administered – and the second charge line, representing the amount of drug wasted, when a JW modifier is present. The online tool makes it so much easier for validation of the drug HCPCS/NDC that requires use of the JZ modifier as well, because the table contains a column indicating that the drug HCPCS has already been vetted by the Centers for Medicare & Medicaid Services (CMS) as being packaged as a single-use vial.

According to Borchard, DrugCode Pro will enhance users’ knowledge of drug HCPCS codes and expedite time spent verifying the drug HCPCS-to-NDC for applicable units reporting, which essentially reduces staff time and staff costs, and ensures compliant billing practices and correct reimbursement for drug charges.

Programming note:

Listen to Talk Ten Tuesday at 10 a.m. Eastern today when senior healthcare consultant reports this story live.