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24.3.17 Injections and Oral Medications
Oral medication must be used in preference to injectable medication in the office and outpatient hospital unless one of the following circumstances applies:
• No acceptable oral equivalent is available.
•Injectable medication is the standard treatment of choice.
•The oral route is contraindicated.
•The client has a temperature over 102°F (documented on the claim and in the medical record) and a high blood level of antibiotic is needed quickly.
•The client has demonstrated noncompliance with orally prescribed medication (documented on the claim and in the medical record).
•Previously attempted oral medication regimens have proven ineffective and are supported by the medical record.
•An emergency situation occurs.
Claims submitted for antibiotic or steroid injections billed in a physician's office (POS 1) or in the outpatient hospital (POS 5) must include modifiers AT, ET, or KX.
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