Oncology & Hematology Coding Alert

We bust drug claim errors that can steal your rightful dollars You could be losing as much as 34 percent of your drug reimbursement if you fall prey to a few common coding pitfalls. What to do: Try this handy breakdown of the top-10 underbilled oncology drugs to help you spot the culprits and know which HCPCS codes apply for these oncology underbilling offenders. Know What to Watch for, Recoup 44 Percent More During a recent Coding Institute audioconference titled "Solid Solutions for Serious Oncology Reimbursement Leaks," Cindy Acker, Tara Cameron, CPC, and Kelly Logan, ROCC, of the Claims Resolution Center (CRC) in Treasure Island, Fla., presented a list of the top-10 underbilled drugs. Drug payments "have drastically decreased since 2004," and practices have been recovering only about 66 percent of the drug charges they could receive reimbursement for, Acker, Cameron and Logan say. Here are the drugs the CRC team singled out: 1. Analyze Lung Cancer Claims for Alimta The most underbilled drug in the lineup, Alimta is a cancer medication that interferes with cancer cells by slowing their growth and spread throughout the body. Practices lost out on as much as $75,000 in reimbursements for this drug due to underbilling in 2007, according to Acker, Cameron and Logan. Almita's primary use is mesothelioma treatment (163.0-163.9, Malignant neoplasm of pleura) as well as non-small cell lung cancer (162.0-162.9, Malignant neoplasm of trachea, bronchus and lung) that has already been treated with other cancer medications. How to code for it: Your HCPCS coding choice for Alimta is J9305 (Injection, pemetrexed, 10 mg). 2. Don't Let Avastin Get Lost in the Mix Coming in at number two is Avastin, a cancer medication that impedes cancer cell growth and slows their spread throughout the body. Your oncologist is likely to use this drug in colon and rectum cancer treatment (153.0-154.1, Malignant neoplasm of colon and Malignant neoplasm of rectum, rectosigmoid junction and anus) and will often combine the drug with other cancer medicines. How to code for it: J9035 (Injection, bevacizumab, 10 mg) is your only option for Avastin. 3. Remember Kytril for Chemo Oncology's number-three most underbilled drug treats and prevents the nausea and vomiting (787.0x, Nausea and vomiting) associated with cancer chemotherapy and radiation therapy. The drug blocks the actions of certain chemicals in the body. How to code for it: For Kytril, use J1626 (Injection, granisetron HCl, 100 mcg). 4. Multiple Myeloma Means Zometa Zometa treats high calcium levels in the blood associated with malignancy by inhibiting calcium release from bones, and your oncologist may use it to treat multiple myeloma (203.0x, Multiple myeloma) and Paget's disease (731.0, Osteitis deformans and osteopathies associated with other disorders classified elsewhere; osteitis [...]