Oncology & Hematology Coding Alert

Question: We received notice that our local coverage determination (LCD) for Neupogen changed, but it looks the same. What's different?

California Subscriber

Answer: The key coding change to the updated Palmetto Part B LCD, effective for services performed on or after June 24, 2011, is a revision of the ICD-9 codes supporting medical necessity. The previous version included 209.70- 209.79 (Secondary neuroendocrine tumors). The updated version lists 209.70-209.75 and 209.79.

Reality: The change does not affect current coverage. The change may seem to suggest that codes 209.76- 209.78 no longer support medical necessity for treatment to reduce the incidence of febrile neutropenia following chemotherapy (the topic of the LCD), but 209.76-209.78 do not exist under ICD-9 2011. Therefore the change simply clarifies which valid codes support coverage.

Helpful: Revisions can be hard to spot, but you should see a list of revisions at the end of the LCD. The list shows a history of the revisions that have taken place over the years so you can identify what's new.

To see the LCD, "Filgrastim (Neupogen), Sargramostim (Leukine), and Pegfilgrastim (Neulasta)," head to www.cms.gov/medicare-coverage-database/  and search L28259 using the Quick Search Document ID box.