Oncology & Hematology Coding Alert
News Flash:
New Drug, No Code
Published on Fri Jun 01, 2001
The FDA has approved a new anti-cancer drug for patients with chronic myeloid leukemia (CML), but Medicare reimbursement will not accompany it. According to HCFA, Gleevec, is a self-administered drug, and therefore not reimbursable. Physicians are limited to prescribing the drug and the patient is responsible for the cost. Novartis, the maker of Gleevec, says the drug will cost $2000 to $2400 per month.
According to a Novartis spokeswoman, commercial payer reimbursement should be done by obtaining prior approval. In addition, physicians can place their patients on a Novartis registry by calling (888) 669-6682. By doing so, the company will contact insurers directly to help patients obtain coverage.
Other Articles in this issue of
Oncology & Hematology Coding Alert
- Determine When To Use Prolonged Service Codes for Extra Time
When an oncology-related visit takes longer than normal, codes +99354-+99355 used to describe a prolonged [...] - Reimbursement for Simulations Depends on Careful Documentation and Medical Necessity
The key to getting paid for simulations in radiation oncology no matter how many are [...] - You Be the Coder:
Coding for an Elevated CA-125
Test your coding knowledge. Determine how you would code this situation before looking at the [...] - Use Code 36540 for Blood Collection but Not Port Flushes
When CPT 2001 included a new code for blood collection from ports, 36540 (collection of [...] - News Flash:
New Drug, No Code
The FDA has approved a new anti-cancer drug for patients with chronic myeloid leukemia (CML), [...] - Reader Question:
Use Code 77370 Correctly
Question: Can more than one special medical physics consult, 77370 (special medical radiation physics consultation) [...] - Reader Question:
Billing for Activase
Question: How should we bill 2 mg of Activase when the HCPCS code (and Medicare [...] - Reader Question:
Coding for CT Scans Without Medical Necessity
Question: I am having problems getting reimbursed for a CT scan of the brain without [...] - Reader Question:
Two Physicians
Question: When can two different physicians (in the same practice) bill for an inpatient visit [...]
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