Medicare Compliance & Reimbursement
FDA Approves Two New Cancer Drugs
Martha Stewart may be going to prison because she bet against ImClone's new cancer drug Erbitux, but careful coding and documentation can keep physicians out of trouble with billing for this drug.
Erbitux is one of two new colorectal cancer drugs that just won Food and Drug Administration approval. The other one, Genetech's Avastin, aims to treat first-line, or previously untreated, colon or rectal cancer. By contrast, Erbitux is designed to treat patients with EGFR-expressing or metastatic colorectal cancer, and particularly ones who are intolerant to irinotecan-based chemotherapy.
Because these are both chemotherapy drugs, physicians should use unlisted code J9999 instead of J3490 to bill for them, says David Davis, medical policy analyst with iHealth Technologies in Atlanta. Also, physicians should supply the name of the drug and the dosage in Box 19 of the paper claim or the comment field of the electronic claim, he adds.
Part B carrier Trailblazer is paying $653 for the 100 mg dose of Avastin, Davis notes.
It's important to have correct ICD-9 diagnosis codes with these drugs, says independent coding consultant Margaret Hickey in New Orleans. With Avastin, Genentech recommends using 153.X (Malignant neoplasm of colon) or 154.X (Malignant neoplasm of rectum, rectosigmoid junction, and anus). Empire Medicare Services says it'll cover Erbitux for 153.0-153.9 and 154.0-154.8.
Erbitux should be administered in combination with Irinotecan or on its own, notes Empire's policy. The first dosage should be 400 mg/m infused over 120 minutes, and the recommended weekly maintenance doses are 250 mg/m infused over 60 minutes, according to Empire. n
Medicare Compliance & Reimbursement
- Dialysis:
For Dialysis Patients, Choose 'Fistula First'
New CMS program sings the praises of a safer, more cost-effective kind of access.
Providers placing [...] - Rehab:
Therapists Getting Caught In Stroke Coding Trap
Choosing the wrong diagnosis can lead to big problems.
If outpatient therapy providers are treating patients [...] - Home Care:
OASIS Suspensions Add More Work For HHAs
Assessment time points added for some.
The suspension of OASIS data collection for private pay patients [...] - Lab Tests:
CMS Clarifies Confusion On Physician Referrals
Find out when physician referrals are and are not acceptable.
If you have been searching for [...] - Hospitals:
Higher Pay On The Way For Reclassified Hospitals
The list of qualifying facilities to be released soon on CMS' Web site.
Good news for [...] - Health Plans:
New Rx Cards Shake Up Managed Medicare Market
Insurers hope to use the cards to drive business for Medicare Advantage products.
Phase I of [...] - Home Care:
CMS Grants Some Assessment Flexibility
The Centers for Medicare & Medicaid Services has thrown home health agencies one bone in [...] - Chronic Care:
CMS Solicits Proposals For Care Coordination Pilot
Ten applicants wanted for 3-year pilot.
The Centers for Medicare & Medicaid Services is seeking proposals [...] - FDA:
FDA Approves Two New Cancer Drugs
Martha Stewart may be going to prison because she bet against ImClone's new cancer drug [...] - Bill Watch
Bill introduced in the House: HR 4195. A bill to amend part D of title [...]
