- Billing incorrect quantities of the drug administered.
- Billing chemotherapy administration codes inappropriately.
As a result of these findings, the Medical Review department implemented audits to suspend claims for specific drugs to determine if the quantity and administration codes are billed correctly. While reviewing these claims, TrailBlazer has also found that in some cases administration codes are billed without a corresponding drug on the same date of service. Drug administration billed without a corresponding drug will result in a denial of the administration code. An example seen during the review was patients purchasing a drug and bringing it to the physician’s office for the drug to be administered by the physician’s staff. In this situation, the physician should:
Bill the HCPCS code for the drug administered with the correct quantity (according to the dose per unit specified in HCPCS) and a zero charge.
Append the KX modifier to all of the administration codes billed for the same date of service.
