Oncology & Hematology Coding Alert

Question: Our physician administered filgrastim has mentioned no other details for the drug administered. We are confused between codes J1442 and Q5101. How can we decide the correct code of the two?

Ohio Subscriber

Answer: Before you submit a claim for filgrastim, you need to confirm if your physician used the parent or the biosimilar product. You can accordingly choose for the following codes:

• J1442 (Injection, filgrastim [G-CSF], excludes biosimilars, 1 microgram)
• Q5101 (Injection, filgrastim [G-CSF], biosimilar, 1 microgram).

Note: The code descriptor of J1442 clearly specifies that the code excludes biosimilars and that for the code Q5101 clearly specifies that the code applies only to biosimilar products.

Reference and biosimilar filgrastim: The parent filgrastim was Neupogen. The first biosimilar approved by the Food and Drug Administration (FDA) is Zarxio, which is a biosimilar version of filgrastim.

What is a biosimilar product? A biosimilar product is a copy of the parent molecule or the reference product which has no clinically meaningful differences from the previously approved product. There may only be minor differences in the two products solely attributable to variation in the clinically inactive components.