However, conditions affecting the gastrointestinal tractincluding pernicious anaemia, Crohn's disease, coeliac disease, or gastric surgerycan significantly impair absorption, necessitating alternative supplementation routes such as intramuscular hydroxocobalamin injections, which deliver B12 directly into the bloodstream
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PMID 2649073
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As initially explained in the September 8, 1998, OPPS/ASC proposed rule (63 FR 47576), we believe that using the IPPS wage index as the source of an adjustment factor for the OPPS is reasonable and logical, given the inseparable, subordinate status of the HOPD within the hospital overall