Oncology & Hematology Coding Alert

Master the difference between single- and multiuse vials Chemotherapy drugs are expensive, and if you-re not billing the unused portions of drugs your practice supplies, you-re losing out. What to do: Under Medicare rules, you often may receive reimbursement for wasted drugs simply by listing the amount of leftover drug, with an appropriate modifier, on line 24 of the CMS-1500 claim form. Know Which -Wasted- Supplies to Report To report drugs the oncologist actually administers to a patient, you should select the appropriate HCPCS supply code (such as J9206, Irinotecan, 20 mg) and list that code in box 24D of the CMS-1500 claim form. You will bill for drugs only if your practice actually purchases and provides the drug, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians and Children's University Medical Group Compliance Program. Occasionally, the oncologist may have to discard an unused portion of a drug. Many drugs have a short "shelf life," and if the physician does not empty an open vial within, for instance, an eight-hour period, she may have no choice except to throw the remaining supply away. For example, during infusion the patient may have an allergic reaction. Although most of the drug supply remains unused, the infusion had begun and you cannot use these supplies for another patient. You must, therefore, "waste" the remaining drug. Quick tip: In the case of a terminated infusion due to patient reaction, your payer may prefer you to include an additional diagnosis code such as V64.1 (Surgical or other procedure not carried out because of contraindication) or E933.1 (Adverse effect, antineoplastic drug) to describe the circumstances of the service. Medicare and other payers will reimburse your practice for wasted drugs, but only for drugs supplied in "single-use vials," notes Jean Acevedo LHRM, CPC, CHC, president of Acevedo Consulting Inc. in Delray Beach, Fla. The oncologist may treat more than one patient from a single-use vial, but she must use the drug within a short time. By contrast, a "multiuse vial" generally treats a larger number of patients, and may be used without "spoilage" over a greater time period. Medicare and other payers will not cover wasted drugs from multiuse vials. Determine Wasted Units, Apply JW If the oncologist must waste a portion of a single-use vial, you should list on the claim form both the amount of the drug the physician administered and the amount she discards. Most payers prefer that you list these as two separate line items. Example 1: The provider administers 125 mg of oxaliplatin (J9263, Injection, oxaliplatin, 0.5 mg), using three 50-mg single-dose vials. Note that each 50-mg vial contains 100 billable [...]