Oncology & Hematology Coding Alert

Find out which code payers might pair with 189.0.

Your fallback for some cancer medications might be J9999 (Not otherwise classified, antineoplastic drugs), but you won't rely on that any longer for Torisel or Treanda intravenous infusions. Each medication now has its own J code, effective for dates of service on or after Jan. 1, 2009.

The FDA approves Torisel (temsirolimus) for injection to treat patients with advanced renal cell carcinoma (189.0, Malignant neoplasm of kidney and other and unspecified urinary organs; kidney, except pelvis). Patients typically receive 25 mg weekly via an IV infusion that takes 30 to 60 minutes (96413, Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug).

The new J code you-ll report for Torisel administration is J9330 (Injection, temsirolimus, 1 mg). Because it's a 1 mg-dosage code, you-ll report J9330 for each mg your staff administers.

Hydration note: If you administer hydration of at least 31 minutes as a secondary or subsequent service in association with 96413 through the same IV access, you should also report +96361 (Intravenous infusion, hydration; each additional hour [List separately in addition to code for primary procedure]). Then append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to indicate the hydration was a separate or sequential service.

"You should use modifier 25 when the physician provided a separate and significant E/M service at the same time as a minor procedure in your office," says Arlene J. Smith, CPC, an insurance, coding, and billing specialist in Washington.

Appropriately appending modifier 25 means that your practice will receive a separate payment for an E/M service that the oncologist performed on the same day as a procedure or other service.

The FDA approved Treanda (bendamustine HCl) In October 2008 to treat patients with indolent B-cell non-Hodgkin's lymphoma (NHL).

Second line therapy: Physicians may administer Treanda injections for NHL that has progressed during or within six months of treatment with rituximab (J9310, Injection, rituximab, 100 mg) or a rituximab-containing regimen.

The approval adds to the current indication for Treanda in the treatment of patients with chronic lymphocytic leukemia (CLL), says Roberta Buell, MBA, an oncology reimbursement consultant and partner with onPoint Oncology LLC.

Heads up: For patients with CLL, the efficacy of Treanda relative to first line therapies other than chlorambucil (S0172, Chlorambucil, oral, 2 mg) has not been established.

When your provider administers Treanda, now report J9033 (Injection, bendamustine HCl, 1 mg) instead of the catch-all code J9999.

Medicare carriers should accept both new codes -- J9330 and J9033 -- for dates of service on or after Jan. 1, 2009. Remember that private insurers might recognize or reimburse for the new J codes differently from Medicare, so check with your local payers before filing the claims.

"Watch for denials from private payers who haven't implemented the new codes," Buell advises. "Let the drug reimbursement hotlines know that these payers are not aware of the new J codes."

Expect more usage: Physicians use both new J codes in an office setting, Buell says. "They are not yet top ten Medicare drugs but are increasing in indications," she says. "Therefore, utilization will rise."