Oncology & Hematology Coding Alert

Plus: Add a stack of J-codes to your toolkit to prevent 2009 denials

For 2009, you-ll find lots of changes to HCPCS codes -- some additions, some deletions, and some drugs merely changing status. Look for several new J-code arrows to add to your quiver. They should make it easier to get paid when your

oncologist or hematologist prescribes the latest treatments.

The hit to your office's budget is the deletion of code G0332 for both hospitals and freestanding centers.

In 2006, CMS approved a temporary payment -- G0332 (Services for intravenous infusion of immunoglobulin prior to administration [this service is to be billed in conjunction with administration of immunoglobulin]) -- to cover the costs of

acquiring and preparing an infusion of intravenous immune globulin (IVIG).

The payment shored up the high-price IVIG during a shortage, says Tiffany Spencer, CPC, ACS-EM, a senior coding and billing consultant from North Carolina. Medicare reimburses about $60-$70 for the code, she says.

Payment for G0332 was continued through 2008, but it comes to an end on Jan. 1. When you give a patient IVIG, your coding will be complete without G0332.

For the nursing staff's work infusing these drugs, you should report 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour). Add on code +96366 (... each additional hour) if the infusion lasts more than 90 minutes.

These codes are also new for 2009. See "CPT Moves Infusion Code Set," page 11.

Hidden trap: Stay away from 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and +96415 (... each additional hour) when coding for IVIG. Those codes are for IV chemotherapy,

monoclonal antibodies, and certain biological response modifiers only.

Example: The physician administers 100 mg of Vivaglobin for a service that lasts less than an hour.

In 2009: For this claim, you just report J1562 (Injection, immune globulin [Vivaglobin], 100 mg) and 96365, along with the appropriate ICD-9 code.

In 2008: You would report J1562, 90765, the appropriate ICD-9 code, and G0332.

Warning: The new crop of HCPCS codes, which take effect on Jan. 1, may give you d-j- vu. That's because you-ve seen some of the descriptors before.

For example: HCPCS 2009 introduces new code J1459 (Injection, immune globulin [Privigen], intravenous, non-lyophilized [e.g., liquid], 500 mg), but deletes Q4097, which for 2008 used the same descriptor as new code J1459.

"This is an instance where Privigen injections -graduated- from the Q-code section, which are temporary codes, to the J-codes, which are more permanent," says Heather Corcoran with CGH Billing in Louisville, Ky. "That's the only difference

between the old and new codes in this category."

Von Willebrand: Likewise, HCPCS will delete Q4096 (Injection, Von Willebrand factor complex, human, ristocetin cofactor [not otherwise specified], per I.U. VWF: RCO) and replace it with J7186 (Injection, antihemophilic factor VII/Von

Willebrand factor complex [human], per factor VIII I.U). The recently approved blood coagulants are "an important advance for patients and their surgeons, providing them access to a proven preventive therapy that can make needed surgery

possible and safer," said Jesse L. Goodman, MD, MPH, director of the Food and Drug Administration's Center for Biologics Evaluation and Research, in a 2007 press release.

And that's not all: Here are more new HCPCS codes to add to your arsenal.

- J0641 (Injection, levoleucovorin calcium, 0.5 mg): Levoleucovorin for injection is a replacement for calcium leucovorin in the NCCN Clinical Practice Guidelines in Oncology. It's part of a treatment regimen for osteosarcoma (170.x, Malignant

neoplasm of bone and articular cartilage).

- J1453 (Injection, fosaprepitant, 1 mg): The Food and Drug Administration (FDA) approved fosaprepitant injection in January to prevent chemotherapy-induced nausea and vomiting, which you would code with 787.01 (Nausea with vomiting),

787.02 (Nausea alone), or 787.03 (Vomiting alone).

- J1930 (Injection, lanreotide, 1 mg): Lanreotide treats acromegaly (253.0, Acromegaly and gigantism) and symptoms caused by neuroendocrine tumors (209.x).

- J8705 (Topotecan, oral, 0.25 mg): Topotecan treats ovarian (183.0, Malignant neoplasm of ovary and other uterine adnexa; ovary) and lung cancers (162.x, Malignant neoplasm of trachea, bronchus, and lung), among others. You-d code J9350

(Topotecan, 4 mg) for the intravenous version.

- J9033 (Injection, bendamustine HCl, 1 mg): The FDA approved bendamustine in October to treat a form of non-Hodgkin's lymphoma (204.1x) that progressed during or within six months of treatment with rituximab or a regimen that includes

rituximab.

- J9207 (Injection, ixabepilone, 1 mg): Marketed as Ixempra, ixabepilone treats malignant breast neoplasms (174.0-175.9).

- J9330 (Injection, temsirolimus, 1 mg): Temsirolimus treats advanced renal cell carcinoma (RCC), which you-d code with 189.0 (Malignant neoplasm of kidney and other and unspecified urinary organs; kidney, except pelvis).

- S3711 (Circulating tumor cell test): Use this code with your Blue Cross Blue Shield patients whom your oncologist tests with CellSearch System. CellSearch is approved to monitor patients who have metastatic breast, metastatic prostate,

and metastatic colorectal cancer.

Don't get left out in the cold of payer rejection; use these refreshed codes for drugs.

In 2008: Until the end of this year, you choose between these codes for iron dextran:

- J1751 -- Injection, iron dextran 165, 50 mg

- J1752 -- Injection, iron dextran 267, 50 mg.

In 2009: On Jan. 1, the more generic J1750 (Injection, iron dextran, 50 mg) replaces these codes. J1750 also replaces deleted code Q4098.

In 2008: When your oncologist prescribes etoposide to treat, for instance, erythroleukemia (207.0, Acute erythremia and erythroleukemia), you code J9182 (Etoposide, 100 mg).

In 2009: Updated code J9181 (Injection, etoposide, 10 mg) replaces J9182. Watch your units; in 2009, you-ll report one unit per 10 mg instead of one unit per 100 mg.

Correction:

"Pump Up Payments With Optimum Prolonged IV Administration Coding" in Oncology & Hematology Coding Alert, Vol. 10, No. 10, stated: "If you administer non-chemotherapy drugs via pump, you must report an unlisted procedure code

such as 90799 (Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion)." That's the wrong code; it should be 90779.

90799 was deleted for 2008 and replaced with 90779. What's more, CPT 2009 will delete 90779 and replace it with 96379.