Oncology & Hematology Coding Alert

Learn which other codes will bring you instant denials starting January 1.

The recently released HCPCS 2011 code-set reveals a slew of deletions, streamlining your drug coding choices. Cisplatin, cyclophosphamide, and vincristine are among the affected drugs. Here are the highlights.

Good news: This change should simplify billing, particularly if the system your practice or facility uses, such as Pyxis or Lynx, limits you to a single code and billable unit for a drug, says Lisa S. Martin, CPC, CIMC, CPC-I, chargemaster specialist for OSF Healthcare System in Peoria, Ill. "As a consultant, I saw different facilities using only the 100 mg code [for example] for that very reason, so this change should facilitate more consistent and compliant billing practices."

Watch out: These changes have a positive side, but "there are always considerations that will arise," Martin says. For example, if your practice uses different vial sizes, you will need to be alert for the different and specific national drug code (NDC) numbers for the agent dispensed to the patient when you send a claim to a payer who requires NDC information, she warns.

Stick to J9060 for Cisplatin

Cisplatin, ordered particularly for patients with metastatic testicular or ovarian neoplasms, or advanced bladder cancers, is one of the many agents affected by the HCPCS 2011 shake-up.

Revise: HCPCS 2011 makes a small wording revision to J9060, notes Roberta Buell, MBA, of onPoint Oncology in her Nov. 9 e-Reimbursement newsletter:

• 2010: J9060 -- Injection, cisplatin, powder or solution, per 10 mg
• 2011: J9060 -- Injection, cisplatin, powder or solution, 10 mg.

Delete: Code J9062 (Cisplatin, 50 mg) will no longer be available for use in 2011.

Result: You should use J9060 to report cisplatin, brand name Platinol, when supplied for 2011 dates of service.

J9070 Comes Out on Top for Cyclophosphamide

Cyclophosphamide is an alkalyting agent that works as an antineoplastic and immunosuppressant. You may see it called Cytoxan or Neosar.

Keep: At 1 unit per 100 mg, J9070 (Cyclophosphamide, 100 mg) won the role of the single option for coding cyclophosphamide injection supply.

Delete: HCPCS 2011 deletes all of the following. Note that all of the lyophilized cyclophosphamide codes will be deleted:

• J9080 -- Cyclophosphamide, 200 mg
• J9090 -- Cyclophosphamide, 500 mg
• J9091 -- Cyclophosphamide, 1.0 gram
• J9092 -- Cyclophosphamide, 2.0 gram
• J9093 -- Cyclophosphamide, lyophilized, 100 mg
• J9094 -- Cyclophosphamide, lyophilized, 200 mg
• J9095 -- Cyclophosphamide, lyophilized, 500 mg
• J9096 -- Cyclophosphamide, lyophilized, 1.0 gram
• J9097 -- Cyclophosphamide, lyophilized, 2.0 gram.

'Liposome' Separates J9098 and J9100

Another antineoplastic affected by the HCPCS revisions is cytarabine, which works to stop DNA replication. You may see it in regimens such as ADE for childhood acute myeloid leukemia.

Keep: HCPCS keeps the code for the liposomal form: J9098 (Injection, cytarabine liposome, 10 mg). This form is also called DepoCyt and can be used in intrathecal administration.

You also still have one code for the non-liposomal form (Cytosar-U): J9100 (Injection, cytarabine, 100 mg).

Delete: HCPCS 2011 deletes the other non-liposomal code, J9110 (Injection, cytarabine, 500 mg).

Report Dacarbazine at 100 mg Per Unit in 2011

Dacarbazine, brand name DTIC-Dome, is an antineoplastic. You may see it used to treat melanoma, Hodgkin's disease, and soft-tissue sarcomas.

Keep: HCPCS 2011 keeps the 100 mg code J9130 (Dacarbazine, 100 mg).

Delete: HCPCS will delete 200 mg code J9140 (Dacarbazine, 200 mg).

Report Mitomycin Per 5 mg in 2011

Antineoplastic antibiotic mitomycin (Mitozytrex, Mutamycin) is prescribed for stomach and pancreas adenocarcinomas, as well as other cancers, including head and neck, breast, non-small cell lung, cervical, bladder, and colorectal.

Keep: HCPCS 2011 holds on to code J9280 (Mitomycin, 5 mg).

Delete: The two other mitomycin codes, J9290 (Mitomycin, 20 mg) and J9291 (Mitomycin, 40 mg), will be deleted in 2011.

Vincristine Codes J9375 and J9380 Join Deleted List

Oncologists may order vincristine (Vincasar PFS) for patients with leukemia, Hodgkin's disease, non-Hodgkin's lymphoma, soft-tissue tumors, and neuroblastoma, among others. You'll be reporting vincristine per milligram in 2011.

Keep: Code J9370 (Vincristine sulfate, 1 mg) will still be valid in 2011.

Delete: You'll no longer be able to report larger increments using J9375 (Vincristine sulfate, 2 mg) or J9380 (Vincristine sulfate, 5 mg) in 2011, says Kelly Loya, CPC-I, CPhT, managing consultant for Los Angeles-based Sinaiko Healthcare Consulting. HCPCS deletes these codes.

Exchange J9350 for J9351 in 2011

Oncologists may order topotecan (Hycamtin) for patients with ovarian or lung cancer that has metastasized and has not improved after other treatments.

For topotecan, you will see a swap of one J code for another in 2011, notes Buell.

Add: In 2011, you should use new code J9351 (Injection, topotecan, 0.1 mg) for this topoisomerase type I inhibitor.

Delete: For services on or after Jan. 1, 2011, you should no longer report J9350 (Injection, topotecan, 4 mg). HCPCS 2011 deletes this code.

The switch from J9350 (4 mg per unit) to J9351 (0.1 mg per unit) is a major difference in strength per unit, says Loya. "Be sure to take care to correctly calculate the billed units or it could mean unnecessary errors with a large revenue difference," she warns.

Note: See the At-A-Glance table on page 92 for a quick look at the code changes.