Oncology & Hematology Coding Alert

Overdoing the attachments will slow down processing time.

Palmetto GBA is urging its providers to take the Goldilocks approach to submitting Herceptin documentation — not too much and not too little, but just right.

Problem: A number of Palmetto’s providers have been submitting multiple pages of supporting documentation with their Herceptin claims (J9355, Injection, trastuzumab, 10 mg), which is slowing down processing time.

Solution: The only supporting documentation Palmetto requires to be submitted is:

·         Patient’s weight in kilograms

·         Dose the physician prescribed (not the administered amount).

“This required documentation is to be submitted in Block 19 for paper claims and in the narrative field for electronic claims (Loops 2330 or 2400; Element NTE02),” Palmetto states in the April 11, 2013, post “Claim Alert: Required Documentation for the Drug Herceptin (trastuzumab).” Search the post name at www.palmettogba.com/palmetto/palmetto.nsf/DocsCat/Home.

Units reminder: “Herceptin has been on the CMS radar for review. Audits have revealed providers submitting the full amount of the vial on the claim regardless of the amount administered,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, director of reimbursement and advisory services for Altegra Health, Inc. “Be aware, Herceptin is supplied in a multi-use vial. Therefore, while very expensive, only the amount given/administered can be claimed for reimbursement. According to the package insert (www.herceptin.com/pdf/herceptin-prescribing.pdf), once reconstituted for use, the vial of Herceptin is stable for 28 days. Be sure to schedule patients in such a way to minimize wasted amounts if at all possible.” Loya advises reviewing the OIG July 2012 report for more information: http://oig.hhs.gov/oas/reports/region5/51200010.pdf.