Is an oral is in-office injections considered prescription drug management

[SwatiR_91462]

We are coming across scenario where in urgent care oral administration of dexamethasone injection is done,for which we only code J series code. This means the administration is included in E/M. Then if this is prescription drug then this can credit for MDM level and counted for risk table prescription drug management. Same for oral tablet which are non-otc. Even these are one time treatment. This discussion is in AAPC forum as well but no clear answer I am getting for this scenario neither any documented proof is there regarding this.

 

[NadineE_92105]

Hey Swati,

Any prescription medication administered or provided directly in the office, where the physician makes the decision to use it for the patient's treatment, generally counts towards "prescription drug management" in the Medical Decision Making (MDM) component of an E/M service.

This includes:

• Oral prescription medications given in the office (like your dexamethasone scenario).
• Injectable prescription medications administered in the office (e.g., a steroid shot, an antibiotic injection, a biologic).
• Prescription-strength topical medications applied in the office.

So you would bill one E/M code that captures the overall visit and medical decision-making, and one J-code for the dexamethasone administered. No separate administration code, these codes are reserved for injections or other non-oral routes. If the dexamethasone was administered via an actual injection, then you would bill a separate administration code in addition to the E/M service and the J-code for the drug.

Hope that answers your question.

 

[SwatiR_91462]

Thank you, Nadine, for your answer. I have found your explanation helpful, but could you please provide any references for your statements? I searched extensively, but I couldn't find any sources confirming this information.

Secondly, I have a question about the second point:

Injectable prescription medications administered in the office (e.g., a steroid shot, an antibiotic injection, a biologic).

If any injectable medication is administered in the office, wouldn't we code that administration separately? If so, wouldn't this mean that it should not be counted as prescription drug management under E/M guidelines? Please correct me if I am misinterpreting anything.

 

[Laureen Jandroep]

For urgent care oral dexamethasone administration:

• Code: J8540 for tablets; no standard code for oral injectable solutions (payer-specific rules apply).
• Billing: Administration is bundled into E/M (no separate charge).
• MDM: Counts as moderate-risk PDM if drug, dose, and decision are documented.
  Always align coding with administration route and payer policies to avoid denials.

https://publications.aap.org/codingnews/article/15/10/10/27262/Coding-Hotline

https://www.cms.gov/files/document/chapter12hcpcscodesa0000-v9999final11.pdf