Oncology & Hematology Coding Alert

Medication might help fight leucovorin shortage -- but at a price.

A nationwide shortage of Leucovorin has providers searching for alternatives to help ease patients- chemotherapy treatments. Enter Fusilev, a potential replacement option that's pricey -- and rather difficult to find in its own right -- but now has its own J code.

Information from the FDA's Center for Drug Evaluation and Research (www.fda.gov/cder) attributes the Leucovorin shortage to "manufacturing delays." The same Web page lists Fusilev with the note that "limited supplies continue to be available."

Fusilev's newly approved J code (J0641, Injection, levoleucovorin calcium, 0.5 mg) becomes effective Jan. 1, 2009.

"The J code should help providers bill accurately, which should enable more rapid reimbursement of Fusilev," Rajesh C. Shrotriya, chairman, chief executive officer, and president of Spectrum Pharmaceuticals said in a prepared statement.

Coverage caution: J0641 falls under coverage category "C," which means coverage depends on the carrier's judgment. Verify coverage and payer guidelines before submitting claims for Fusilev.

Medicare's allowable for Fusilev is $104.67 and the medication comes in a 50-mg single dose vial.

Oncologists often prescribe leucovorin in combination with other chemotherapy drugs to either enhance effectiveness or help reduce the side effects of certain chemotherapy drugs (such as methotrexate). Treatment for colon, rectal, head, neck, esophageal, or other gastrointestinal tract cancers can incorporate Leucovorin.

Patients receive leucovorin as an intramuscular injection, short IV infusion, or pill (physicians often administer leucovorin concurrently with oxaliplatin). You report J0640 (Injection, leucovorin calcium, per 50 mg) for treatment your staff provides. If your oncologist prescribes oral treatment, you won't code it because the patient will take the prescription to his pharmacy for fulfillment.

Fusilev is indicated after high-dose methotrexate therapy in osteosarcoma; physicians can also prescribe it to reduce the effects of methotrexate or "counteract the effects of impaired methotrexate elimination and of inadvertent overdosage of folic acid antagonists," according to a story at www.freshnews.com on Nov. 7, 2008.