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Oncology & Hematology Coding Alert

HCPCS 2004 Update:

Don't Short-Change Your Office on J Code Dose Amounts

Published on Thu Jan 01, 2004

Follow these tips to correctly bill doses

The key to reporting some of HCPCS 2004's new cancer-related J codes is to pay close attention to the dose amounts, coding experts say.
 
Most of these J codes replace codes that listed higher dose amounts. That means if you submit the new codes under the old doses, you could end up with denials or inappropriate reimbursement.
 
HCPCS adds the following codes:
 

  •  J9178 - Injection, epirubicin HCl, 2mg. You should now report J9178 instead of J9180, which HCPCS deleted. Old code J9180 represented 50 mg of epirubicin. New code J9178 represents 2 mg. The physician may use
    epirubicin in chemotherapy administration to treat several cancers, including breast (174.x) and lung (162.x, Malignant neoplasm of trachea, bronchus, and lung) cancers, says Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent oncology coding consultant based in New Orleans.
     
  •  J2353 - Injection, octreotide, depot form for intramuscular injection, 1 mg. Code J2353 replaces deleted code J2352, which Medicare created in April. You should report J2353 when the oncologist provides a "depot form" of octreotide in a 1-mg intrasmuscular injection. Oncologists may use this drug to treat diarrhea associated with chemotherapy for colon cancer (153.x, Malignant neoplasm of colon).
     
  •  J2354 - Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg. You would report J2354 instead of J2353 for octreotide when the physician administers a "non-depot form" of the drug in 25-mcg doses, using subcutaneous or intravenous methods.
     
  •  J2505 - Injection, pegfilgrastim, 6 mg. This code replaces temporary code Q4053. Often physicians use pegfilgrastim to raise a patient's white blood cell count following chemotherapy, Hickey says.
     
  •  J2783 - Injection, rasburicase, 0.5 mg. If a chemotherapy patient has high levels of uric acid associated with the cancer treatment, your oncologist may give the patient rasburicase to decrease the uric acid. In that case, you would use new code J2783.

    If you use the above codes, make sure your claim reflects the updated dose amount the J code carries, says Carolyn M. Davis, CMA, CPC, CCP, CCS-P, CPHT, TMC, billing supervisor for Oncology Hematology West in Papillion, Neb.
     
    For example, prior to 2004, if your oncologist administered 300 mg of epirubicin to a patient, you would have reported J9180 (Epirubicin ... 50 mg) and then noted the number of 50-mg units the physician used (6 units).
     
    Now, however, if the oncologist provides 160 mg of epirubicin, not only will you have to assign new code J9178 but you will also have to report the amount used in 2-mg units. That means you should bill 80 units of epirubicin.
     
    And if you report the new code (J9178) but use the old dose amount (50 mg), you can expect reduced payments and possibly denials.

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