Oncology & Hematology Coding Alert

But CMS is fighting the cut

Medicare's Neulasta reimbursement may not cover your costs, but the HHS Office of Inspector General wants Medicare to lower your reimbursement on five other oncology drugs.

The OIG claims CMS overpays for J9045 (Carboplatin, 50 mg) by 185.1 percent, J1100 (Injection, dexamethasone sodium phosphate, 1 mg, use for Decadron) by 65.2 percent, and J1260 (Injection, dolasetron mesylate, 10 mg, use for Anzemet) by 55.6 percent.

The survey found that two others, J9390 (Vinorelbine tartrate, per 10 mg, use for Navelbine) and J1626 (Injection, granisetron HCl, 100 mcg, use for Kytril), also had double-digit overpayments.

The law requires CMS to slash drug payments if the OIG finds at least a 5 percent overpayment. CMS insists that the OIG's data didn't take into account decreases that happened since last year, but the OIG says even with recent cuts, the drugs are still much more than 5 percent overvalued. Bottom line: Cuts may be on the way.

The OIG's numbers are based on volume discounts that a small rural practice can't obtain, rural Wisconsin oncology coder Mary Peterson told the June 27 physician Open-Door Forum.