Oncology & Hematology Coding Alert

Diagnosis code F17.2 will go into effect July of this year.

Oncology coding has undergone some significant reforms for this year, which means it's up to you to make certain your practice is adopting them. Now is the right time to check if your practice is aligned to these changes. Here are some of the key changes you cannot ignore.

Check Out These New J Codes

Effective Jan 1, 2016, you have the following J codes applicable in an oncology setting:

• J9299, Injection, nivolumab, 1 mg
• J9032, Injection, belinostat, 10 mg
• J9271, Injection, pembrolizumab, 1 mg
• J9308, Injection, ramucirumab, 5 mg

Let's break down each of these codes.

J9299: You submit one unit of J9299 for every 1 mg of nivolumab.

Indications for nivolumab: Your physician will prescribe nivolumab for the following conditions:

• Unresectable or metastatic melanoma
• Metastatic non-small cell lung cancer (NSCLC) and progression on or after platinum-based chemotherapy
• Advanced renal cell carcinoma who have received prior anti-angiogenic therapy.

Dosage of nivolumab: The recommended dose for nivolumab is 3 mg/kg over one (1) hour, every two (2) weeks administered as intravenous infusion.

J9032: You submit one unit of J9032 for every 10 mg of belinostat.

Indications for belinostat: Your physician will prescribe belinostat for patients with relapsed or refractory peripheral T-cell lymphoma (PTCL).

Dosage of belinostat: The recommended dosage of belinostat is 10,000 mg/m2 administered over 30 minutes by intravenous infusion once daily on days one to five (1-5) of a twenty-one (21) day cycle. Cycles may be repeated every twenty-one (21) days until disease progression or unacceptable toxicity.

J9271: You submit one unit of J9271 for every 1 mg of pembrolizumab.

Indications for pembrolizumab: Your physician will prescribe pembrolizumab for unresectable or metastatic melanoma and for metastatic NSCLC expressing PD-L1 receptor.

Dosage of pembrolizumab: The recommended dose of pembrolizumab is 2 mg/kg over thirty (30) minutes as an intravenous infusion every three weeks.

J9308: You submit one unit of J9308 for every 5 mg of ramucirumab.

Indications for ramucirumab: Your physician will prescribe ramicirumab for NSCLC, gastric and colorectal cancer.

Dosage of ramucirumab: The recommended dose of ramicirumab is 8 mg/kg every two (2) weeks over sixty (60) minutes administered as an intravenous infusion.

Note: The medication dosing information is provided as a general informational note of interest only and should not be used for any treatment related purpose. The manufacturer package inserts or applicable medical text must be referenced by the appropriate qualified professional for more detailed information.

What are National Drug Codes (NDC)?

NDC codes are unique, three-segment number, which are essentially universal product identifier for drugs. The FDA publishes the listed NDC numbers and the information submitted as part of the listing information in the NDC Directory, which is updated daily.

Zeros in NDC codes: You may find leading 'zeros' in NDC codes. The NDC codes have leading 'zeros' to make them complete eleven (11) digit codes in order to meet the Health Insurance Portability and Accountability Act (HIPAA) code set standards.

Listed below are NDC codes for different strengths of nivolumab, belinostat, pembrolizumab, and ramucirumab.

Mark This Advance in Prostate Cancer Therapy

Effective October of last year, you have a discrete HCPCS code C9743 (Injection/implantation of bulking or spacer material [any type] with or without image guidance [not to be used if a more specific code applies]) to report the application of spacer gels in patients with prostate cancer.

The HCPCS code C9743 falls in the category of Outpatient Prospective Payment System (OPPS) Ambulatory payment classification (APC) 0310. In the hospital setting, this code will be reimbursed at the same amount for other codes (For example, code 55876 for device placement in prostate; code 49411 for placement of devices into the abdomen; and code 32553 for insertion of markers into the thorax) in this category.

Do not claim for markers or gels: The code for markers, A4648 (Tissue marker, implantable, any type, each) and that for gel, A4649 (Surgical supply; miscellaneous), are packaged into the reimbursement of the placement code. You do not submit these codes with C9743.

Unlisted code does not always apply: Make sure your practice has adopted this change and is no longer submitting the rectal unlisted CPT® code 45999 (Unlisted procedure, rectum).

Watch the 'C' category: HCPCS code C9743 is a 'C' category code. This means that MPFS does not recognize this code for payment. Your physician should not report this to CMS. This may seem perplexing. When your physician reports the work performed, the best alternative seems to be using the unlisted code which would reflect this procedure under MPFS.

Check with your payer: Before you submit code C9743, check with your payer for reimbursement policies. Meet the documentation requirements for your payers.

Prepare for F17.2 Diagnosis Codes Effective July This Year

CMS has modified its coding policies for low-dose CT lung cancer screenings of current smokers. CMS has set July 5, 2016 as the date for implementation for addition of ICD-10-CM codes F17.2 (Nicotine dependence) to the Medicare National Coverage Determination (NCD) 210.14 list of approved codes for low-dose computed tomography (LDCT) lung cancer screening.

Effective July 1, with an implementation date of July 5, 2016, Medicare Administrative Contractors (MACs) will add the following ICD-10-CM diagnostic codes representing a current smoker:

• F17.210, Nicotine dependence, cigarettes, uncomplicated
• F17.211, Nicotine dependence, cigarettes, in remission
• F17.213, Nicotine dependence, cigarettes, with withdrawal
• F17.218, Nicotine dependence, cigarettes, with other nicotine-induced disorders
• F17.219, Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders

Your claims will not be held till July: Though the new codes will be implemented in July this year, your claims until then will not be held. Until July 1, 2016, you can submit ICD-10-CM code Z87.891 (Personal history of nicotine dependence) on LDCT claims to ensure proper payment.

Resources:

• CMS change request published in Feb this year: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2016-Transmittals-Items/R1630OTN.html
• Medicare Coverage of Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) >https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2015-Transmittals-Items/R3374CP.html?DLPage=1&DLEntries=10&DLFil­ter=9246&DLSort=1&DLSortDir=ascending
• >https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2015-Transmittals-Items/R185NCD.html?DLPage=1&DLEntries=10&DLFil­ter=9246&DLSort=1&DLSortDir=ascending.