Oncology & Hematology Coding Alert

Look for new codes for both hematological and non-hematological chemotherapy.

Effective Jan. 1, 2014, you’ll have new codes for cancer treatment agents, biological response modifiers, and other treatment options, like chlorpromazine and zoledronic acid, thanks to CMS. Changes you’ll need to be aware of include adjustments in the units you can bill; HCPCS 2014 also brings more specific codes for interferon beta-1A.

Many Agents Get New Chemotherapy Codes

If you report treatment of acute lymphocytic leukemia (ALL), chronic myeloid leukemia (CML), multiple myeloma, breast cancer, and colorectal cancer, table 1 has new options you should keep in mind.

In 2014, the new J codes for the chemotherapeutic agents have a change in the per unit amount when compared to the C code options that in 2013.

Old way: In 2013, you reported pertuzumab with HCPCS code C9292 (Injection, pertuzumab, 10 mg Injection) for each 10 mg, by OPPS providers and a limited number of qualified non-OPPS providers. Those who did not qualify to report a C HCPCS code were required to use a HCPCS code for the drug with an unlisted code.

New way: In 2014, you will report one unit of J9306 for every one mg dose of pertuzumab, as indicated in MLN Matters Article MM5027, Change Request R976CP. (See https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM5027.pdf).

Vincristine also has a new HCPCS code, J9371 (Injection, vincristine sulfate liposome, 1 mg) for the liposomal formulation of vincristine sulphate. In 2013, only J9370 (Vincristine sulfate, 1 mg) was available forcing an unlisted code to report this formulation. Now the liposomal formulation can be reported with the new J code.

Check New Code for Oral Anti-Emetic

If your practice reports anti-emetics, watch for the new code for oral chlorpromazine hydrochloride. As of Jan. 1, 2014, you report code Q0161 (Chlorpromazine hydrochloride, 5 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen) for 5 mg dose of chlorpromazine over a 48 hour period.

Remember: You submit claims for chlorpromazine using a Q code. You should make sure that your physician indicates on the order that the beneficiary is receiving the oral antiemetic drug(s) as full therapeutic replacement for an intravenous anti-emetic drug as part of a cancer chemotherapeutic regimen. This is a mandate for the Medicare benefit.

Report Q0161 with Confidence

Keep the following four important tips in mind when reporting Q0161:

1. Make sure it’s for full therapeutic replacement: Medicare pays for oral anti-emetic drugs when used as full therapeutic replacement for intravenous dosage forms as part of a cancer chemotherapeutic regimen. The oral anti-emetic should be administered or prescribed by a physician for use immediately before, at, or within 48 hours after the time of administration of the chemotherapeutic agent.
2. Keep in mind the 48- hour period: The allowable period of covered therapy includes the date of service of the chemotherapy drug (day one counted as beginning at the time of treatment), plus a period not to exceed two additional calendar days, or a maximum period up to 48 hours.
3. Document the chemotherapy: You can report the oral anti-emetic drug(s) which are prescribed by your physician only on a per-chemotherapy-treatment basis. In this scenario, you report code V58.11 (Encounter for antineoplastic chemotherapy) as your primary diagnosis code. This makes it clear that the patient presented for chemotherapy.
4. Watch the units: You report one unit of Q0161 for 5 mg of chlorpromazine.

Medicare Offers a Single J Code for Zoledronic Acid

The year 2013 has been a year of transition for zoledronic acid codes. In July 2013, the code Q2051 (Injection, zoledronic acid, not otherwise specified, 1 mg) was introduced for zoledronic acid with coverage status C, meaning “carrier judgment.” The following two codes for zoledronic acid were no longer payable by Medicare:

• J3487, Injection, zoledronic acid (Zometa), 1 mg
  
• J3488, Injection, zoledronic acid (Reclast), 1 mg
  

Now all three codes (Q2051, J3478, and J3488) have been deleted as of Dec. 31.2013.

What is new in 2014? In 2014, you look to specific code J3489 (Injection, zoledronic acid, 1 mg) for zoledronic acid. This code applies to both “Zometa” and “Reclast” preparations of zoledronic acid. You report one unit of J3489 for every mg dose of zoledronic acid.

When does a physician typically order the use of zoledronic acid? Look for the terms “Zometa” and “Reclast” in the clinical note. “Zometa” is prescribed for cancer-related bone complications and high blood calcium levels. “Reclast” is typically ordered to treat women with osteoporosis. Several companies have received approval for generic versions of Zometa. Generic Reclast has also recently become available.

Watch For Change in Dose Units for Interferon Beta-1A

In 2013, you have the following options for interferon beta-1A:

• J1826, Injection, interferon beta-1A, 30 mcg
• Q3025, Injection, interferon beta-1A, 11 mcg, for intramuscular use
• Q3026, Injection, interferon beta-1A, 11 mcg for subcutaneous use.

You may have faced a challenge for reporting these codes as many payers accepted either J1826 or Q3025. Medicare classified J1826 with an “I” status indicator or “Not valid for Medicare purposes.”

Review Your New Options For 2014

Depending upon the route of administration, check the following new codes for interferon beta-1A:

• J1826, Injection, interferon beta-1a, 30 mcg
• Q3027, Injection, interferon beta-1A, 1 mcg for intramuscular use
• Q3028, Injection, interferon beta-1A, 1 mcg for subcutaneous use.

Key differences: With the new Q codes, you will report Q3027 and Q3028 for every 1 mcg dose of interferon, whereas in 2013, you reported codes Q3025 and Q3026 for every 11 mcg dose. In 2014, the calculation of the units becomes easy as the units you can report now directly correspond to the dose administered. The J code for the injection (J1826) will remain the same and be reported as 1 unit for each 30 mcg administered.

Report Administration of Interferons

Though interferons are not chemotherapeutic agents, you are correct to use 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic) for reporting the administration.

CPT® explains that, due to the complexity of biological response modifier administration, injecting interferons intramuscularly involves a similar complexity and resources as compared to chemotherapy administration. Consider investigating the listing of agents qualifying for reporting code for the administration of the anti-neoplastic agents. This includes administration of BRMs for indications other than cancer.

You can also report 96401 for parenteral administration of non-radionuclide anti-neoplastic drugs or substances such as certain monoclonal antibody agents, but again check the carrier’s policy to avoid unnecessary denials and appeal when appropriate if you and/or the physician doesn’t agree with the payment policy compared to CPT® guidance.

Earn for IVIg Demonstration

Beginning in 2014, you can report code Q2052 (Services, supplies and accessories used in the home under the Medicare intravenous immune globulin [IVIg] demonstration) for the items and services needed for in-home administration of IVIg for the treatment of primary immune deficiency diseases.

Background: This IVIg demonstration project will be conducted for a period of three years and not more than 4,000 Medicare beneficiaries are likely to be enrolled. This demonstration program will be covered under Title I, Section 101 of the “Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act” amending part B of title XVIII of the Social Security Act. You can read more about the project on http://innovation.cms.gov/initiatives/IVIG/.

Editor’s note: You can download the new codes from www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html.