Medicare Compliance & Reimbursement

Hot on the heels of the new CPT 2008 introduction, you've got more new codes to assign to your claims with the introduction of several HCPCS codes effective Jan. 1. Here's how the new codes break down by specialty:

Ophthalmology: The big news for ophthalmology coders is that you now have a code to report Lucentis (J2778). Gone will be the days of using unclassified codes J3490 (Unclassified drugs) or J3590 (Unclassified biologics) for this drug.

Oncology: HCPCS deletes previous panitumumab code C9235 and debuts new code J9303 (Panitumumab injection, 10 mg).

"Panitumumab is a very useful drug and will be used a lot," says Barbara L. McAneny, MD, CEO of New Mexico Oncology Hematology Consult-ants Ltd. in Albuquerque. "When drugs are new, they get average wholesale priced for a while, so CMS likes to get them specific codes ASAP. That hurts us in price, but forces private payers to acknowledge the drug as standard of care."

Endocrinology: If you were frustrated with the lack of specificity when reporting Supprelin LA, you'll be able to abandon J3490 in favor of new code J9226 (Histrelin implant, Supprelin LA, 50 mg).

Urology: Because HCPCS introduced J9226, the existing histrelin implant code (J9225) will now have a new descriptor indicating that it specifically refers to Vantas.

Skin substitutes: In addition, HCPCS will make skin substitute coding easier with the debut of J7347 (Integra matrix), J7348 (Tissuemend) and J7349 (Primatrix).

"It's nice to have specific codes to attach to specific products," says Linda Martien, CPC, CPC-H, of National Healing Corporation. "It's often more of a challenge to select the correct application codes, especially when coders don't understand the difference between allograft, xenograft, metabolically active, non-metabolically active, etc."

Gastroenterology: You'll also gain specificity when coding claims for G-tube and J-tube equipment. HCPCS deletes B4086, which covered claims for both standard- and low-profile tubes. In its place, you'll be able to choose from B4087 (for standard tubes) and B4088 (low-profile tubes).

What's not there: If you were looking for a code to replace J3490 for Cardizem, Tiazac, sodium bicarbonate or Tensilon, you're not in luck this year.

Deletions, additions: HCPCS 2008 also moves several codes from the "Q" category to the "J" section. "Any time a HCPCS code goes from Q to J, it means that it used to be a temporary code, and now it's got a permanent code status," explains Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach for the American Academy of Professional Coders in Salt Lake City.

Immune globulin: For example, since July you've been reporting immune globulin injections with Q4087-Q4088 and Q4091-Q4092. But Medicare deletes those codes for Jan. 1, and now you'll report:

• J1561 for Gamunex injections,

• J1562 for Vivaglobin,

• J1568 for Octagam,

• J1569 for Gammagard liquid,

• J1571 for Hepagam B, and

• J1572 for Flebogamma.

Orthopedics: Your head may still be spinning from last year's about-face on Synvisc and Hyalgan injections, but HCPCS once again has changed the coding guidance for these drugs.

In 2007, CMS changed sodium hyaluronate coding by introducing Q4083, Q4084, Q4085 and Q4086 in place of the previous J codes that HCPCS originally recommended.

But on Jan. 1, you'll be able to toss out those Q codes, and instead report:

• J7321 for Hyalgan or Supartz,

• J7322 for Synvisc,

• J7323 for Euflexxa, and

• J7324 for Orthovisc.