Oncology & Hematology Coding Alert

Plus: See what’s different for Erwinaze, Adcetris, mitomycin, and more.

Other specialties may be reeling from CPT® 2013 changes, but for oncology and hematology, HCPCS is where the action is. Factor these medication supply code updates into your coding to start your New Year off on the right foot.

Add Another Chapter to the Doxil Story

Doxil coding saw quite a few changes in July 2012, and the saga continues for HCPCS 2013, effective January 1. The updated code set deletes both J9001 (Injection, doxorubicin hydrochloride, all lipid formulations, 10 mg) and the temporary code added in July, Q2048 (Injection, doxorubicin hydrochloride, liposomal, Doxil, 10 mg).

In place of Q2048, HCPCS 2013 adds J9002 (Injection, doxorubicin hydrochloride, liposomal, Doxil, 10 mg).

Note that Q2049 (Injection, doxorubicin hydrochloride, liposomal, imported Lipodox, 10 mg) will still be valid in 2013 for imported Lipodox, which has been used to alleviate the Doxil shortage.

Distinguish Erwinaze From Other Asparaginase

Another new HCPCS 2013 code is J9019 (Injection, asparaginase [Erwinaze], 1,000 IU) for the chemotherapy drug asparaginase, which is sold under the name Erwinaze.

To avoid confusion, HCPCS also revised the definition of existing code J9020 to indicate it’s for “not otherwise specified” asparaginase:

·         2012: J9020, Injection, asparaginase, 10,000 units

·         2013: J9020, Injection, asparaginase, 10,000 units, not otherwise specified.

Adcetris Has a New Permanent Code

HCPCS 2013 also offers a new specific code for the targeted antibody-drug conjugate Adcetris: J9042 (Injection, brentuximab vedotin, 1 mg).

Previously, outpatient facilities were able to report the supply of this drug using C9287 (Injection, brentuximab vedotin, 1 mg), but that code is no longer valid in 2013.

Adcetris has been approved for use in patients with Hodgkin lymphoma “after failure of autologous stem cell transplant or after failure of at least two prior multi-agent chemotherapy regimens in patients not eligible for transplant,” states the May 8, 2012, HCPCS Public Meeting Agenda. It goes on to state that Adcetris “is also indicated for the treatment of systemic anaplastic large cell lymphoma (sALCL) after failure of at least one prior multi-agent chemotherapy regimen.”

Steer Clear of Ophthalmic Mitomycin Code

HCPCS 2013 revises your code for mitomycin, which is used to treat a variety of cancers. These may include lung, stomach, colon, rectal, and pancreatic cancers. It is an antineoplastic antibiotic that helps prevent cancer cells from multiplying. The code revision adds the term “injection” to the definition:

·         2012: J9280, Mitomycin, 5 mg

·         2013: J9280, Injection, mitomycin, 5 mg.

Watch for: HCPCS 2013 adds another code for mitomycin, but it is specific to ophthalmic uses: J7315 (Mitomycin, ophthalmic, 0. 2 mg). According to the May 8, 2012, HCPCS Public Meeting Summary Report, Jim Anderson of Mobius Therapeutics was the primary speaker for this new code request. Mobius makes the mitomycin product Mitosol, which is used to treat glaucoma by topical application during surgery.

Bottom line: Keep your oncology coding in the clear by ensuring you use injection code J9280 rather than ophthalmic code J7315.

J1569 Is Now OK for Sub-Q Admin

Immune globulin codes will see some minor revisions for 2013.

The first is the deletion of the outdated brand name Gamunex from J1561:

·         2012: J1561, Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), non-lyophilized (e.g. liquid), 500 mg

·         2013: J1561, Injection, immune globulin, (Gamunex-C/Gammaked), non-lyophilized (e.g., liquid), 500 mg.

The second change removes the term intravenous from Gammagard Liquid code J1569:

·         2012: J1569, Injection, immune globulin, (Gammagard Liquid), intravenous, non-lyophilized, (e.g., liquid), 500 mg

·         2013: J1569, Injection, immune globulin, (Gammagard Liquid), non-lyophilized, (e.g., liquid), 500 mg.

The revision ensures that J1569 use is not limited to intravenous Gammagard Liquid. In particular, the code can now apply to subcutaneously administered Gammagard Liquid, as well.

J7178 Completes the Fibrinogen Transition

HCPCS 2013 deletes two human fibrinogen concentrate codes:

·         J1680, Injection, human fibrinogen concentrate, 100 mg

·         Q2045, Injection, human fibrinogen concentrate, 1 mg.

Instead, you now have new code J7178 (Injection, human fibrinogen concentrate, 1 mg). The change places this code with the other clotting factor codes and acts to “standardize the ‘unit’ definition among the various clotting factors at 1 mg,” according to the Summary.

Look to J1741 for IV Ibuprofen

The code for intravenous ibuprofen has moved from a temporary hospital-outpatient C-code into the realm of the J codes in 2013.

HCPCS 2013 deletes C9279 (Injection, ibuprofen, 100 mg) and adds J1741 (Injection, ibuprofen, 100 mg).

IV ibuprofen is sold under the brand name Caldolor. The drug is available in 400 mg/4 ml single-dose vials or in 800 mg/8 ml single-dose vials. The physician may order IV ibuprofen to manage pain or reduce fever.

Watch Units for Relistor

HCPCS 2013 has added a new code for Relistor, which is used to treat patients with opioid-induced constipation: J2212 (Injection, methylnaltrexone, 0. 1 mg).

Unit calculations could be a trouble spot for this code. The initial code request suggested that a single unit should represent up to 12 mg. This amount falls in line with the recommended dose of Relistor, which “is 8mg for patients weighing 38 kg to less than 62 kg (82 lb to less than 136 lb) or 12 mg for patients weighing 62 kg to 114 kg (136 lb to 251 lb),” the Summary states.

Instead, the code definition indicates each 0.1 mg represents a single unit. To calculate units, you should divide the amount administered by 0.1. So for a 12 mg dose, divide 12 by 0.1 for a total of 120 units.

Resource: The May 8, 2012, HCPCS meeting agenda and summary are available from the Downloads section of www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCSPublicMeetings.html. The complete HCPCS 2013 list is available from www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html.