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Oncology & Hematology Coding Alert

HCPCS 2004 Update:

Speed Up Reimbursement With New Chemotherapy Drug Codes

Published on Thu Jan 01, 2004

Get what you deserve with J9098, J9263 and J9395

If you thought you could use only the unclassified J9999 to report cytarabine liposome, oxaliplatin, and fulvestrant, think again. HCPCS 2004, which took effect Jan. 1, created three new chemotherapy-related J codes that should make your drug coding more specific and quicken reimbursement.
 
Overall, HCPCS 2004 introduces three new chemotherapy drug codes that replace J9999 (NOC [not otherwise classified], antineoplastic drug):
 
 

  •  J9098 - Cytarabine liposome, 10 mg.  Generally, oncologists use this drug in chemotherapy to treat various types of leukemia, such as monocytic leukemia (206.x).
     
  •  J9263 - Injection, oxaliplatin, 0.5 mg. Physicians use chemotherapy administrations of oxaliplatin on patients with colon cancer (153.x, Malignant neoplasm of colon).
     
  •  J9395 - Injection, fulvestrant, 25 mg. You may report this code when your oncologist uses fulvestrant to treat patients with breast cancer (174.x).

    Before using new HCPCS codes, practices should check with payers to make sure they have begun accepting the 2004 codes, oncology coding experts advise.
     
    For more on how to use other new HCPCS J codes, see the related story, "Don't Short-Change Your Office on J Code Dose Amounts," on page 10.
     
    New Codes Simplify Billing

    Not having to rely on J9999 to report cytarabine (J9098), oxaliplatin (J9263) and fulvestrant (J9395) means less coding and billing hassles for oncology practices, says Carolyn M. Davis, CMA, CPC, CCP, CCS-P, CPHT, TMC, billing supervisor for Oncology Hematology West in Papillion, Neb.
     
    These new codes will make your chemotherapy coding easier for three reasons:
     

  •  Reporting classified drugs means that payers know exactly what drug they're paying for, Davis says. When you submit J9999, your insurer must rely on an abundance of documentation to know what drug your oncologist used. The documentation includes a description of the drug, the drug's strength, and a billing invoice that verifies costs, she says. 
     
  •  You need less documentation to prove medical necessity for J9098, J9263, and J9395. For example, if you bill for J9098, you should support its use with standard medical documentation. This includes supplying an ICD-9 code, such as V58.1 (Chemotherapy), and describing the cancer, the dose, and the treatment plan.
     
  •  Insurers may reimburse J9098, J9263 and J9395 faster than they reimbursed J9999, Davis says. Because you have to submit additional documentation when you report J9999, you may encounter delays in submitting the code, or the insurance company could request additional documentation before paying. But when you report a classified code, the insurance company will have fewer reasons for delaying your payment.
     
    Also, having a classified J code to report means that your practice can use electronic billing, says Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent oncology coding consultant based in New Orleans. In other words, submitting J9098, J9263 and J9395 beats using J9999 "hands down" because you have to submit J9999 manually, she adds. That means you will get your classified J code claims in faster, which, in turn, should speed up reimbursement.

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