Oncology & Hematology Coding Alert

Add 2 new Q codes to your system to keep your coding compliant.

The July 2013 HCPCS update has coding changes in store for both liposomal doxorubicin HCl and zoledronic acid. Pay attention both to the new codes available and the coverage changes Medicare will make to existing codes.

Resource: To view the complete list of updates, download the file for July 1, 2013, from www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS_Quarterly_Update.html.

Doxil’s J9002 Will Switch to ‘Not Payable by Medicare’

Doxil code J9002 (Injection, doxorubicin hydrochloride, liposomal, Doxil, 10 mg) was added just a few months ago in January. But effective July 1, 2013, Medicare will change the code’s coverage status from D, “Special coverage instructions apply,” to I, “Not payable by Medicare.”

On the same date, Medicare will add a new liposomal doxorubicin HCl code with special coverage status D: Q2050 (Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10mg).

History: These changes are the most recent in a long line of code revisions that have happened during the Doxil shortage, which began in 2011. In February 2013, the FDA announced it had approved a generic version of Doxil, made by Sun Pharma Global FZE (www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm337872.htm).

You may recognize the name Sun because it produces Lipodox, which is also liposomal doxorubicin HCl. The FDA allowed Lipodox to be imported to ease the Doxil shortage. Imported Lipodox is coded using Q2049 (Injection, doxorubicin hydrochloride, liposomal, imported Lipodox, 10 mg), which became effective in July 2012.

Indications: Liposomal doxorubicin HCl is used to treat patients with ovarian cancer and multiple myeloma, as well as other cancers.

Q2051 Will Offer New Zoledronic Acid Option

Another July 1 code addition relates to zoledronic acid. The new code will be Q2051 (Injection, zoledronic acid, not otherwise specified, 1 mg).

Medicare lists coverage status C for this code, which means “Carrier judgment,” says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, of MJH Consulting in Denver, Colo. So “national Medicare is leaving the coverage issue for this code up to each individual Medicare contractor or carrier for determination. Practices will need to look to their specific Medicare contractor as to whether they will cover this drug.” 

On the same date, CMS will change the coverage status for two existing zoledronic acid codes:

·         J3487, Injection, zoledronic acid (Zometa), 1 mg

·         J3488, Injection, zoledronic acid (Reclast), 1 mg.

Zometa code J3487 will change from C to I, which means “Not payable by Medicare.” Code J3488 for Reclast will change from D, “Special coverage instructions apply,” to I. So neither code will be payable by Medicare.

Indications: 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.

Take Changes in Stride Using These Tips

“Practices need to remember that just because there are mid-year changes for Medicare coverage for these HCPCS codes, that does not mean that all commercial payers will follow suit,” says Hammer. For instance, “Some commercial payers only update their files annually and not quarterly like Medicare.”

Consequently, you’ll want to put some thought into marking status changes for J9002, J3487, and J3488 in your billing software. “Some practice management systems have the capability to indicate alternate codes for specific payers, i.e., J9002 for some payers and Q2050 for Medicare. Other practice management software has the capability to individually discontinue a code for only specific payers, i.e., discontinue J9002 for Medicare only,” says Hammer. You can work with your software’s capabilities to create a pre-payment flag regarding the Medicare coverage changes, she adds.