Oncology & Hematology Coding Alert

HCPCS Level II:

Are You Using the Latest Drug Supply and “G” Codes in Your Oncology Practice? Find Out

Published on Fri Feb 19, 2021

Check your private payers to see if they, too, are using quality measures.

If the sheer number of new HCPCS Level II codes related to oncology and hematology coding has you in a daze, you’re not alone. Help is here. We’ve broken down what’s pertinent to you so that you — and your claims — will have the most current information.

Note: Check Oncology Coding Alert volume 23 number 2’s article “Start Your 2021 Right by Focusing on New HCPCS Level II G Codes” to learn about more general physician services codes.

“All employees within the Revenue Cycle management team should always educate themselves on upcoming code changes,” says Amy C. Pritchett, BSHA, CCS, CPC, CPC-I, CANPC, CPMA, CASCC, CDEO, CRC, CPMP, CMPM, CMRS, CEDC, C-AHI, Senior Consultant at Pinnacle Enterprise Risk Consulting Services LLC in Mobile, Alabama.

For example, if you look at this update, a long-utilized code (G0297, Low dose ct scan (ldct) for lung cancer screening) was deleted and converted to a Category I CPT^® code (71271, Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)). “Without the knowledge of this significant coding change, professionals would continue to assign and submit reimbursement for an invalid code — potentially leading to a lack of reimbursement and/or lag in payment due to refiling and denials,” Pritchett says.

Start by Learning About These New Drug Supply Codes

Many oncologists are rejoicing about A9591 (Fluoroestradiol f 18, diagnostic, 1 millicurie), a diagnostic substance for PET scans. The reason is that Cerianna (fluoroestradiol F-18) is the first FDA-approved F-18 PET imaging agent specifically indicated for use in patients with recurrent or metastatic breast cancer.

You’ll also see the following oncology related drug supply HCPCS Level II codes:

C9068 (Copper cu-64, dotatate, diagnostic, 1 millicurie)
C9069 (Injection, belantamab mafodontin-blmf, 0.5 mg)
C9070 (Injection, tafasitamab-cxix, 2 mg)
C9072 (Injection, immune globulin (asceniv), 500 mg)
C9073 (Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose)

For hematology coders, you should note these two new and one revised drug supply medication codes:

J1823 (Injection, inebilizumab-cdon, 1 mg)
J7189 (Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram)
J7212 (Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram)

Oncology coders will also have these additional injectable medication codes at their disposal (the last two of which are related to breast cancer):

J9144 (Injection, daratumumab, 10 mg and hyaluronidase-fihj)
J9223 (Injection, lurbinectedin, 0.1 mg)
J9281 (Mitomycin pyelocalyceal instillation, 1 mg)
J9316 (Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg)
J9317 (Injection, sacituzumab govitecan-hziy, 2.5 mg)

You also have a new Q code related to injectable medications, which is:

Q5122 (Injection, pegfilgrastim-apgf, biosimilar, (nyvepria), 0.5 mg)

Note: The codes listed above represent the supply of the drug. Be sure to review the documentation and assign the appropriate administration code(s) in addition to the medication administered supply.

Don’t Overlook The Following G Codes

These G codes relate to oncology services. Those denoted with a “*” are revised:

*G0068 (Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual’s home, each 15 minutes)
*G0069 (Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual’s home, each 15 minutes)
*G0070 (Professional services for the administration of intravenous chemotherapy or other intravenous highly complex drug or biological infusion for each infusion drug administration calendar day in the individual’s home, each 15 minutes)
G0088 (Professional services, initial visit, for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual’s home, each 15 minutes)
G0089 (Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual’s home, each 15 minutes)
G0090 (Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual’s home, each 15 minutes)

Example: If your provider goes to a Medicare patient’s home for an initial visit to administer intravenous chemotherapy for thirty minutes total, you should report G0090 x 2, because G0090 specified “each 15 minutes.” Notice how all of the codes above include that same time measurement.

Also, check out the difference between G0088-G0090 (initial visit) and G0068-G0070 (subsequent services). Since G0068-G0070 do not have that verbiage in the description, don’t miss out on the initial code. Then the other codes would be used for subsequent visits. Since G0088-G0090 were newly added, make sure you submit them in the correct order in 2021, or you could be facing code edits when submitting claims.

Capture These New/Revised Quality Measures

Additionally, you have specific quality measure codes oncology/hematology practices can now use. They are both new and revised (as denoted by “*”):

G2205 (Patients with pregnancy during adjuvant treatment course)
G2206 (Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy)
G2207 (Reason for not administering adjuvant treatment course including both chemotherapy and her2-targeted therapy (e.g. poor performance status (ecog 3-4; karnofsky =50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course))
G2208 (Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy)
*G9537 (Imaging needed as part of a clinical trial; or other clinician ordered the study)
*G9945 (Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis)

Remember: “These quality measures are normally only recognized by Medicaid or Medicare as they are ‘G’ codes, but it is always prudent to check with your commercial payers in case they also have developed quality programs that would make reporting these advantageous to the practice,” says Melanie Witt, RN, MA, an independent coding expert based in Guadalupita, New Mexico.

Oddity: In addition to these G codes, you have two revised M codes to use, as of Jan. 1, 2021. They are:

M1041 (Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis)
M1051 (Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis)

These codes have the same descriptors, but the HCPCS short descriptor has M1041 of “Pt cr ft inf im or pt id si” while M1051 has a short descriptor of “Pt w/cancer scoliosis.”

However, notice how codes G9945, M1041, M1051 all have the same descriptors. “That is very strange,” says Suzan Hauptman, MPM, CPC, CEMC, CEDC, director, compliance audit, Cancer Treatment Centers of America. HCPCS Level II was “late with publishing, and I’m wondering if corrections will be published.”

Cross These Deleted Codes Off Your Coding Option List

As you usher in new and revised HCPCS Level II codes, you should also remove the deleted codes from your potential coding list. Deleted codes (effective 1/1 21) include: