We have done something similar, but we key off a query from the MSP form that says "Do you have ESRD?". We then have a pharmacy rule set up that bills the correct billing code depending on the answer to this query. We set up a rule for each dose of the drug.
Rule Lookup
Mnemonic Description
1 ESRDARA100 PATIENT HAS ESRD RULE
2 ESRDARA200 PATIENT HAS ESRD RULE
3 ESRDARA300 PATIENT HAS ESRD RULE
4 ESRDARA40 PATIENT HAS ESRD RULE
5 ESRDEPO10K PATIENT HAS ESRD RULE
6 ESRDEPO20K PATIENT HAS ESRD RULE
7 ESRDEPO40K PATIENT HAS ESRD RULE
8 ESRDEPO4K PATIENT HAS ESRD RULE
Enter/Edit Rule
Page 1
Mnemonic ESRDARA100 Print On Order
History
Active? Y Print From PCI
N
Description PATIENT HAS ESRD RULE POM Enabled?
N
Data Flds from RX Evaluate at
TXN
Eval Stock Meds
;RULE TO CHARGE A DIFFERENT BILL CODE DEPENDING ON IF THE PATIENT HAS
ESRD ;USES CUSTOM KEYWORD DEFINED WITH INSURANCE 'MCRAB' AND INS QUERY
'INSMS11AA'
;IF QUERY SET TO 'Y' THEN CODE OF 2510006 USED ELSE REGULAR CODE
2500006 USED IF{[f z insurance info]="Y" [f rx set billing
code]("2510006");[f rx ok]};
Sandy DePlonty
War Memorial Hospital
500 Osborn Blvd
Sault Ste. Marie, MI 49783
Phone: (906)635-4663
Fax: (906)635-4467
[EMAIL PROTECTED]
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-----Original Message-----
From: Carla Fuller
Sent: Tuesday, October 24, 2006 8:31 AM
To: Sandy G. Deplonty; Katie H. Wood
Subject: FW: [MEDITECH-L] epoetin j-code
Carla Fuller, CPC
War Memorial Hospital
Applications Specialist
500 Osborn Blvd
Sault Ste. Marie, MI 49783
(906) 635-4663
[EMAIL PROTECTED]
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of
[EMAIL PROTECTED]
Sent: Friday, October 20, 2006 6:18 PM
To: 'Brennan, Robert'; [email protected]
Subject: RE: [MEDITECH-L] epoetin j-code
Hi Robert-
You need two separate billing numbers (Procedure Codes) in B/AR and a
query answered by Nursing - Does this patient have ESRD? Then write a
Keyword in PHA looking at the query and have a PHA Rule "re-set" the
billing number and put a comment in the Rx Comment field as a note.
[f z esrd.patient]^ESRD,
"Billing Code changed to ESRD J-CODE"^MSG, "Epo ESRD"^RXCMT,
IF{ESRD="Y" [f rx set billing code]("41012010"), ([f rx set rx
comment](RXCMT)), ([f rx msg](MSG)); 1};
Works very well - the catch is adding the query for Nursing to
answer...and if you can sneak in a required query without them knowing,
it's a done deal.
Best of luck - Kevin.
PS - For most facilities, the dollar amount comes from PHA so remember
the "alternate procedure code" will have to have a dollar amount and get
updated too.
Kevin McConnell, PharmD.
Clinical Consultant
(713)480-6810
[EMAIL PROTECTED]
www.RPhInformatics.com
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]
On Behalf Of Brennan, Robert
Sent: Wednesday, October 18, 2006 1:38 PM
To: [email protected]
Subject: [MEDITECH-L] epoetin j-code
Does anyone have some insight they would like to share concerning how
epoetin billing is handled. I know that there are two J-Codes associated
with the drug, one for ESRD and one for Non-ESRD. As the code is based
on diagnosis and as diagnosis and J-Codes can not be modified on the PHA
side, I'm not sure how this can be handled. Is there a rule out there
that selects the code based on diagnosis?
Thanks
Bob
Robert Brennan RPh
St Joseph Health Services of Rhode Island Department of Pharmacy 200
High Service Ave N. Providence, RI 02904
(401) 456-3522
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