Oncology & Hematology Coding Alert

Lesson: Don't assume every J9xxx code qualifies for chemotherapy administration codes.

If your practice sees patients with Part B coverage through Noridian, you'll need to take note of a new drug administration rule from this Medicare Administrative Contractor (MAC). Being in the know will help you properly report gonadotropinreleasing hormone (GnRH) injections.

This rule affects practices in Arizona, Utah, North Dakota, South Dakota, Wyoming, and Montana, with Noridian Administrative Services as their MAC, as well as practices in Alaska, Oregon, and Washington, which Noridian covers under a legacy contract.

Learn the Crux of the Change

As of March 1, 2011, you shouldn't be using administration code 96402 (Chemotherapy administration, subcutaneous or intramuscular; hormonal antineoplastic) or any other chemotherapy administration code with some agents as you have in the past.

According to Noridian, the administration of GnRH, also known as luteinizinghormone releasing hormones (LHRH), or its analogs, does not meet the CPT manual requirements for the use of the chemotherapy administration codes. Noridian's announcement offers no additional rationale to explain why the MAC is treating Lupron Depot, a biological response modifier, as a less complex therapeutic administration. Abbott's package insert for dosage and administration of Lupron Depot describes the great instability of the medication and the particular care required to properly administer it.

Official version: Noridian published the information below in the March 2, 2011, Medicare B News, Issue 268, and posted it as news on Jan. 21, 2011:

Medicare considers the use of the chemotherapy administration codes to appropriately describe the parenteral administration of the following drugs ONLY:

• J1745 Injection Infliximab
• Any non-GnRH drug/compound listed in the current HCPCS section 'CHEMOTHERAPY DRUGS J9000-J9999.'
• Examples of GnRH and analogs include but are not limited to J9217 [Leuprolide acetate (for depot suspension), 7.5 mg] and J9218 [Leuprolide acetate, per 1 mg].

Follow the Timeline From April 2010

The March 2, 2011, announcement indicates it updates the June 2, 2010, Medicare B News, Issue 262, which included the following information (originally posted as news April 7, 2010). Note that this version doesn't reference GnRH coding:

Medicare considers the use of the chemotherapy administration codes to appropriately describe the parenteral administration of the following drugs:

Any drug listed in the current HCPCS section 'CHEMOTHERAPEUTIC DRUGS J9000-J9999' and the biologic response modifier, J1745 Injection Infliximab, 10 mg.

But wait, there's more: On May 6, 2010, Noridian posted an update effective as of June 15, 2010, specifically referencing J9217 and J9218: Medicare considers the use of the chemotherapy administration codes to appropriately describe the parenteral administration of ONLY the following drugs:

J1745 Injection Infliximab

Any drug listed in the current HCPCS section 'CHEMOTHERAPY DRUGS J9000-J9999' with the exception of GnRH and analogs, J9217, J9218.

Bottom line: The revision effective March 1, 2011, clarifies that Noridian considers chemotherapy administration codes to be incorrect not just for J9217 and J9218, but for any GnRH or analog.

FYI: Noridian considers J9218 to represent a self-administered drug and therefore does not cover it. You'll find Noridian's self-administered drug list at www.noridianmedicare.com/macj3b/coverage/self_administered_drugs_determination.html.

Impact: Turn To 96372 Now for Noridian

Many practices have used 96402 to report administration when giving Lupron Depot (J9217).

But for Noridian, at least, you should not report 96402 for the administration. Instead of chemotherapy drug administration codes 96401-96549, you should choose a code from the 96360-96379 code series, according to the MAC.

New way: The most likely replacement is injection code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for GnRH analogs such as Lupron, Zoladex, and Trelstar, says Michael A. Ferragamo, MD, FACS, clinical assistant professor at the State University of New York at Stony Brook.

Example: A patient comes to your office for a Lupron Depot injection. In the past you may have reported 96402 for the Lupron administration and J9217 for the drug. But for a Noridian patient, you should report 96372 and J9217.

"Reimbursement is less on 96372 than for 96402," warns Ann Hayden, office manager at Urology Specialists in Phoenix." Based on national rates, the difference is roughly $12.00 per unit.

Resource: You can review the most recent announcement, "Chemotherapy Administration, March 1, 2011, Revision," by downloading the March 2, 2011, Medicare B News bulletin (issue 268) from www. noridianmedicare.com/macj3b/(click on "Bulletins" under "Top Tasks").

Keep in mind: If you are under a Medicare contractor other than Noridian, remember that each is allowed to decide which drugs are appropriate for use with chemotherapy administration codes.