Wiki use of HCPCS code Q0163 when it's not chemo related?

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I'm coding for urgent care and the providers often give oral Diphenhydramine HCL to handle other symptoms that are nothing to do with chemo. Web MD lists all kinds of uses for the drug, non of which are chemo related specifically, yet the only oral HCPCS code for the drug specifically states for use at the time of chemo treatment. (Q0163)

Does anyone know if I can use this code even when not related to chemo or do I have to use the J8499 - prescription drug, oral, non-chemo, NOS? (or some other HCPCS code I may be missing)
Thank you.
 
You cannot use the Q0163 code in a non chemo situation. There is no code for giving this drug orally in any other scenario and most payers will not reimburse using the unlisted code. For what reason is your provider giving to his patients while in the office?
 
mitchellde said:
You cannot use the Q0163 code in a non chemo situation. There is no code for giving this drug orally in any other scenario and most payers will not reimburse using the unlisted code. For what reason is your provider giving to his patients while in the office?
Click to expand...

I wish it was that clear-cut. We are remote coding and the dictation leaves a lot to be desired as it's mostly populating into boxes, not a real description from the provider. A list of meds given and a list of problems but not a real connection between them with whys and wherefores.

However, the one I have right now was an MVA with HA, LOC, neck stiffness and neck pain. Numbness in the arms that comes and goes. Denied dizziness, N/V. Final Dx neck strain.

Not sure right now what other reasons they use it for.
 
I am not sure how you can code notes that are not complete. You cannot code a medication without a note that indicate that it was administered and for what reason. Most of the time oral medications are not billable in the office setting. In the scenario you provided I see no correlation for the medication. How do you know it was even given at the visit and it is not a listing of meds they take at home? I code remote and If I cannot find a reference in the note then I do not code it. Even the problem list.. if it is not within the documentation I do not code it. You just cannot code from lists provided.
 
There is an A9150 for Non-prescription drugs. Benadryl orally is OTC. You didn't mention the insurance. I don't think Medicare will pay for it but some of the other carriers might pay a little.

Dee

Coder-H said:
I'm coding for urgent care and the providers often give oral Diphenhydramine HCL to handle other symptoms that are nothing to do with chemo. Web MD lists all kinds of uses for the drug, non of which are chemo related specifically, yet the only oral HCPCS code for the drug specifically states for use at the time of chemo treatment. (Q0163)

Does anyone know if I can use this code even when not related to chemo or do I have to use the J8499 - prescription drug, oral, non-chemo, NOS? (or some other HCPCS code I may be missing)
Thank you.
Click to expand...
 
mitchellde said:
I am not sure how you can code notes that are not complete. You cannot code a medication without a note that indicate that it was administered and for what reason. Most of the time oral medications are not billable in the office setting. In the scenario you provided I see no correlation for the medication. How do you know it was even given at the visit and it is not a listing of meds they take at home? I code remote and If I cannot find a reference in the note then I do not code it. Even the problem list.. if it is not within the documentation I do not code it. You just cannot code from lists provided.
Click to expand...

I agree. It's not a list per se, and is documentation, just not the way every other group does it regarding MDM. There is often a lack of actual narrative from the providers, but enough info to code from in most instances. They state the meds were administered in the urgent care, with dose, method and time, separate from any prescribed meds, which are noted in a different section. Insurance BTW is UHC.
 
I see but without anything regarding the medical necessity of giving this in the office rather than than the patient picking it up on the way home, I would not code it all.
 
Fair enough. That certainly makes sense and helps give me piece of mind on this situation. I was just hanging up a little in case there was maybe something we could use. Thank you.
 
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