Ask Dr. Z

What are the inpatient billing guidelines for Revenue Code 636 on commercial (non-Medicare) facility claims? Our facility would like clarification regarding when it is appropriate to bill pharmacy items under Revenue Code 636 on commercial (non-Medicare) inpatient facility claims, as some of our commercial contracts have inpatient reimbursement clauses outlined for Revenue Code 636. We know that for Medicare claims, Revenue Code 636 is used for: 1) Inpatient – exclusively billing hemophilia clotting factors. 2) Outpatient – billing for "Drugs that require detail coding" (i.e., pharmacy with HCPCS). Are commercial (non-Medicare) claims required to adhere to Medicare inpatient billing guidelines for Revenue Code 636, or can "drugs that require detail coding" (i.e., pharmacy with HCPCS) be billed under Revenue Code 636? If possible, please provide references so that we may support our decision.