News Brief: Turn Orphans Into Pass-Through Payment This Fall

Earn more money for certain drugs and biologicals
Starting Oct. 1, you can earn payment for C9717 (Hemorrhoidopexy, complex or extensive, by a circular stapler). This code now maps to APC 150 and will gain you a whopping $1,210 in reimbursement.
You can earn pass-through payment for two new orphan drugs starting Oct. 1: C9218 (Injection, azacitidine, per 1 mg) and C9219 (Mycophenolic acid, oral, per 180 mg). Both of these items were approved by the Food and Drug Administration earlier this year (C9218 on May 19, and C9219 on Feb. 27), so for administration performed between those dates and Sept. 30, report them using C9399 (Unclassified drugs or biologicals). When you administer them Oct. 1 or after, use the more specific HCPCS code.
Remember: With the code change for these two products comes a status indicator change, so be aware of this in the outpatient code editor (OCE): They move from status indicator K (Blood or blood products) to G (Drug pass-through).
Three more new HCPCS codes also jump into the picture, so prepare for their addition to the OCE:
G0341 - Percutaneous islet cell transplant, includes portal vein catheterization and infusion
G0342 - Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion 
G0343 - Laparotomy for islet cell transplant, includes portal vein catheterization and infusion.

- Published on 2004-11-22