Oncology & Hematology Coding Alert

Good news: In many cases, you’re shifting from a temporary code.

The Centers for Medicare and Medicaid Service (CMS) released a bunch of new, revised, and deleted Healthcare Common Procedure Coding System (HCPCS) codes relevant to oncology practices.

How to prepare? Be sure to update your charge master, electronic dictionaries, and charge form to reflect all code and/or unit changes for 2019. “It is also a good idea to review code and unit changes with nursing staff and/or charge entry staff, depending on who is calculating the billing units ... This will eliminate rebills or incorrect billing recoupments from third-party payors,” says Kelly Loya, CPC-I, CHC, CPhT, CRMA, Associate Partner at Pinnacle Enterprise Risk Consulting Services LLC located in Charlotte, North Carolina.

If drug unit calculations are performed electronically, ensure those fields are up to date in the charge master or electronic billing system files so the quantity is correctly reflected in billing.  

Smart advice: The code changes are effective Jan. 1, 2019, so complete updates and education beforehand and set the effective date in the system to January 1, 2019 to alleviate errors, Loya advises.

2 New ‘A’ Codes Brush Aside Temporary ‘C’ Codes

First up, you should get to know A9513 (Lutetium lu 177, dotatate, therapeutic, 1 millicurie). “This is a medication used to treat gastroenteropancreatic neuroendocrine (GEP-NET) tumors positive for the hormone receptor somatostatin, including GEP-NETs in the foregut, midgut and hindgut,” says Sally Eagan, BS, RHIT, CCS, CCDS, AHIMA Approved ICD-10-CM/PCS Trainer; Managing Consultant at Pinnacle Enterprise Risk Consulting Services LLC located in Atlanta, Georgia.

Replaces: You should delete C9031 which was the temporary code.

Secondly, you should check out A9589 (Instillation, hexaminolevulinate hydrochloride, 100mg). Oncologists will use this “in the cystoscopic detection of non-muscle invasive papillary cancer of the bladder among patients suspected or known to have lesion(s) on the basis of prior cystoscopy,” Eagan says.

Replaces: Be sure to delete temporary code C9275.

High Risk Breast Cancer Patients Could Mean Reporting New Code C8937

Remember: “C-codes generally mean reimbursement for a drug or procedure and often apply to new technology items or services,” says Sarah Goodman, MBA, CHCAF, COC, CCP, FCS, president and CEO of SLG Inc. in Raleigh, North Carolina.

Oncologists may see high risk breast cancer patients who require a breast MRI. If that’s the case, you’ll report new code C8937 (Computer-aided detection, including computer algorithm analysis of breast MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation (list separately in addition to code for primary procedure)).

Replaces: You should delete both C8904 (Magnetic resonance imaging without contrast, breast; unilateral) and C8907 (Magnetic resonance imaging without contrast, breast; bilateral).

See What Else is New for ‘C’ Codes

Suppose your oncologist treats an adult patient with “relapsed/refractory mucosis fungoids (MF) or Sezary syndrome (SS), which are difficult to treat as they are subtypes of cutaneous T-cell lymphoma,” Eagan says. In this case, you should get to know new code C9038 (Injection, mogamulizumab-kpkc, 1 mg).

Also, check out new bronchoscopy code C9751 (Bronchoscopy, rigid or flexible, transbronchial ablation of lesion(s) by microwave energy, including fluoroscopic guidance, when performed, with computed tomography acquisition(s) and 3-d rendering, computer-assisted, image-guided navigation, and endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]) and all mediastinal and/or hilar lymph node stations or structures and therapeutic intervention(s)). “This new procedure may be of interest” to oncologists, Eagan says.

Deletion: On the other hand, you should strike off C9748 (Transurethral destruction of prostate tissue; by radiofrequency water vapor (steam) thermal therapy) from your coding possibilities. C9748 is deleted effective 1/1/2019.

Jump into These New Injection Codes

You’ve got seven new injection codes to learn.

First up is J0185 (Injection, aprepitant, 1 mg) or brand name EMEND®. Oncologists use this drug “in the prevention of acute and delayed chemotherapy induced nausea and vomiting,” Eagn says.

Replaces: Code J0185 replaces the temporary code C9463.

You should also highlight J1454 (Injection, fosnetupitant 235 mg and palonosetron 0.25 mg) or brand name AKYNZEO^®. Oncologists use this drug to “inhibit acute and delayed chemotherapy-induced emesis, Eagan says.

Replaces: You should delete the temporary code C9033.

In other words, an injection of AKYNZEO^® is indicated in combination with dexamethasone in adults for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy.

Similarly, you will have the option of reporting J2797 (Injection, rolapitant, 0.5 mg). Oncologists use this drug for the treatment of chemotherapy-induced nausea and vomiting. You’ll use this code for the injectable version of the medication.

The following injection may be important for hematology—and that’s J7170 (Injection, emicizumab-kxwh, 0.5 mg). “HEMLIBRA^® uniquely addresses the factor deficiency of hemophilia A,” Eagan says.

Additionally, you will have J9044 (Injection, bortezomib, not otherwise specified, 0.1 mg) for patients with multiple myeloma. This drug is also known as VELCADE^®.

Finally, you should learn two new rituximab codes starting in January—J9311 (Injection, rituximab 10mg and hyaluronidase) and J9312 (Injection, rituximab, 10 mg). These new codes specify a strength change. “RITUXAN^® (rituximab) is indicated for the treatment of low-grade or follicular CD20-positive non-Hodgkin’s lymphoma as a single-agent therapy,” Eagan says.

Replace: These codes replace J9310 (Injection, rituximab, 100 mg).

Be careful: This is a unit per HCPCS code change. You will report the new code for every 10mg, whereas before the old code reported only per 100mg. Therefore, if the change isn’t accurate in your system, you may inadvertently under report the amount of medication administered.

Single Dose Vial: Rituxan is supplied in single dose vials. So, when reporting a dose that is less than a full vial, and the remaining amount is wasted, document the amount wasted and report the units on a separate line with the modifier JW (Drug amount discarded/not administered to any patient) for Medicare. Be sure to check other third-party payor reporting requirements for variations in reporting waste, Loya says.

Editor’s Note: See the Hematology & Oncology Coding Alert Volume 20, Number 11 article, “Bust These 5 Myths to Boost Your J9310, J9035 Coding Accuracy,” for more information on reporting medication wastage amounts.