Oncology & Hematology Coding Alert

Comply with new narrative requirements to prevent denials.

Palmetto GBA providers take note. The J1 and J11 Part B MAC has added an allowed diagnosis code to its Kyprolis coding guidelines.

Background: In an earlier version of the guidelines, Palmetto GBA instructed its providers to report J9999 (Not otherwise classified, antineoplastic drugs) for the supply of Kyprolis (carfilzomib). To show medical necessity, the earlier guideline instructed providers to report 203.02 (Multiple myeloma, in relapse). This guideline was reviewed in "203.02 Is Required on Kyprolis Claims, Palmetto Says" in Oncology & Hematology Coding Alert, vol. 14, no. 12.

Update: A new version of the guideline, updated Dec. 10, 2012, adds 203.00 (Multiple myeloma, without mention of having achieved remission) as a diagnosis code that will help support medical necessity for Kyprolis administration.

To complete the claim, Palmetto instructs physicians that the "Narrative must state ‘patient shows disease progression.’" Additionally, the claim should include the name of the drug, the NDC number, and the dose administered.

Resource: Palmetto posted the guidelines for both J1 and J11 Part B providers. Start at www.palmettogba.com/medicare. In the left-hand menu, choose the link for either the J1 or J11 Part B MAC. On the resulting page, choose Browse by Topic and then Drugs & Biologicals. In the list at the bottom of the new page, click "Kyprolis (Carfilzomib) Coding and Billing Guidelines and Indications" to access the posting.