Oncology & Hematology Coding Alert

If you were confused by Transmittal 1962, you weren't alone.

Coding for discarded drugs and tobacco cessation counseling just got a little clearer. Check out these two recent CMS transmittals to be sure you're applying the rules correctly.

1. Look to Contractor for JW Details

Medicare's recent update regarding modifier JW (Drug amount discarded/not administered to any patient) caused enough confusion that CMS has released a clarification.

What you need to know: Your contractor determines:

• whether it requires modifier JW for discarded-drug claims
• the details of how to document the discarded drug information
• the details of how to apply those rules on the claims

The contractor is also responsible for notifying your practiceabout those rules. So in addition to reading through the official CMS guidance, be sure to reference your specific MAC or local carrier website for any additional requirements regarding modifier JW and discarded-drug claims.

You'll find the original transmittal (1962) at www.cms.gov/Transmittals/downloads/R1962CP.pdf and related MLN Matters article at www.cms.gov/MLNMattersArticles/downloads/MM6711.pdf.

You can see the clarifying transmittal at www.cms.gov/Transmittals/downloads/R758OTN.pdf and related MLN Matters article at www.cms.gov/MLNMattersArticles/downloads/MM7095.pdf.

2. Update Tobacco Cessation Counseling Coverage

If you've been writing off tobacco cessation counseling as nonpayable, it's time to change your tune.

In the past, you could collect for 99406-99407 (Smoking and tobacco use cessation counseling visit ...) if you performed tobacco cessation counseling for a patient with a tobaccorelated disease or with signs or symptoms of one. But on Aug.25, CMS announced that "under new coverage, any smoker covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicarerecognized practitioner who can work with them to help them stop using tobacco."

"For too long, many tobacco users with Medicare coverage were denied access to evidence-based tobacco cessation counseling," said Kathleen Sebelius, HHS secretary, in an Aug. 25 statement. "Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence."

The expanded coverage announcement is part of a focus in the Affordable Care Act, effective Jan. 1, 2011, that expands preventive care service coverage. The new tobacco cessation counseling coverage expansion will apply to services under Medicare Part B and Part A.

"The new benefit will cover two individual tobacco cessation counseling attempts per year," CMS indicated in an Aug. 25 news release. "Each attempt may include up to four sessions, with a total annual benefit thus covering up to eight sessions per Medicare patient who uses tobacco."

"We know that older adults and other Medicare beneficiaries can be successful in their struggles to stop using tobacco, as long as they have the right resources available to them," said HHS's Howard Koh, MD, MPH, in an Aug. 25 statement. "Today's decision will assure that beneficiaries can access that help from qualified physicians and other Medicare-recognized practitioners." To read the complete coverage decision, visit www.cms.gov/center/coverage.asp. Click on "NCAs," then scroll down to "Smoking & Tobacco Use Cessation Counseling." Or go straight to the decision memo at www.cms.gov/mcd/viewdecisionmemo.asp?id=242.