Oncology & Hematology Coding Alert

Until recently, the only readily available reference to determine a "medically accepted indication" for off-label use of an anticancer chemotherapeutic regimen was the American Hospital Formulary Service-Drug Information (AFHS-DI) compendium. Recently, however, CMS has provided another option.

On June 5, CMS decided "drugs and biologicals used in the treatment of cancer are not benign agents"; therefore, to safeguard Medicare beneficiaries who have cancer, "the explicit identification of indications that are not medically accepted [for anticancer drugs] is as necessary as the identification of indications that are medically accepted."

Translation: CMS wants patients to know if they are receiving treatment that has not been medically accepted for their condition.

To that end, the agency has approved the National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium as a reference for off-label use of anti-cancer agents. The NCCN "includes a summary of the pharmacologic characteristics of each drug or biological, information on dosage, recommended or endorsed uses in specific diseases, and is indexed by drug or biological rather than by disease," as CMS explains.

CMS will base its coverage decisions on NCCN recommendations. The agency states, "Indications that the NCCN Drugs and Biologics Compendium lists as -Recommended- will be considered medically accepted indications for the purposes of determining coverage policy. Indications - -Not Recommended- will not be considered medically accepted indications for the purposes of determining coverage policy."

You may access a continually updated NCCN Drugs and Biologics Compendium at http://www.nccn.org/Registration/login/login.aspx?s=SOT.