The monoclonal antibody infusions may seem like old news at this point, especially as mask restrictions loosen and Covid-19 fears decrease. However, healthcare workers continue to battle the Covid-19 and utilize the monoclonal antibodies under the FDA Emergency Use Authorization (EUA). In a previous Pharmacy Revenue Cycle Newsletter, we outlined information required to bill these monoclonal antibodies as they are approved by the FDA EUA.
While the monoclonal antibodies are provided free of charge, each organization may be faced with decisions on how to operationalize the medication use process. Typical combination products are manufactured as a single agent such as the ceftazidime and avibactam example. Bamlanivimab and etesevimab require a pharmacy to prepare each product into a single infusion. Depending on the medication record build, an EMR may or may not allow for the NDC to be scanned upon preparation by the pharmacy teams which may disallow the NDC to be reported. Medication records may charge $0.01 on each component which produces two charge lines requiring billing to combine and ensure the accurate HCPCS with one billed unit. HCPCS can generally be crosswalked to an individual drug product. Only when these products are used in combination would the Q0245 be an appropriate code. This may create confusion to HIM or coding teams when applying the appropriate administration code.
SHOUT-OUTS! Pharmacy and revenue integrity teams should collaborate to determine how the organizations would like to manage the monoclonal antibodies.
a. Determine plan for suppressing charges or billing a token charge along with the administration.
b. Determine if the drug build and preparation of the drug produces the intended effect (e.g. NDC, billing units, HCPCS)
Revenue Integrity team should monitor or conduct a self audit to ensure no claims were billed with dates of service after April 16, 2021 with HCPCS Q0245 or M0239.
Pharmacy and Revenue Integrity teams should continue to monitor the landscape of the Covid-19 infusions. When organizations begin to incur the cost of these products, they may become an area of billing risk.