Oncology & Hematology Coding Alert

Remember to watch for denials that Medicare may overturn on appeal.

In last month's issue, Oncology and Hematology Coding Alert covered the problem of fulvestrant claims being denied based on Medically Unlikely Edits (MUEs). An April 1, 2011, update to the MUE files should have solved that problem by increasing the number of units of J9395 (Injection, fulvestrant, 25 mg) that you may report on a single claim-line.

If you received MUE-based denials for J9395 for dates of service between Jan. 1, 2011, and March 31, 2011, you may appeal those denials after April 1.

Good news: Palmetto GBA and others have indicated that J9190 (Injection, fluorouracil, 500 mg) MUEs were also under review and should have been updated April 1.