Oncology & Hematology Coding Alert

Question: We've seen conflicting information on reporting clotting factor units to Medicare. Do we report the number of IUs administered or something else?

California Subscriber

Answer: Typically, you should calculate units by dividing the amount administered by the amount listed in the code descriptor. Payers may have specific rules, however.

As a Jurisdiction 1 Part B provider reporting clotting factor units for a Medicare beneficiary, you should follow the instructions posted by Palmetto GBA at www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7REJY77083?opendocument&utm_source=J1BL&utm_campaign=J1BLs.

Palmetto instructs its Jurisdiction 1 providers to "divide the number of International Units (IUs) administered by 100 and round to the nearest whole number." It also offers specific rounding rules that you should follow:

• Fraction from .50 to .99 = 1 additional billing unit
• Fraction from .01 to .49 = NO additional billing unit.

Palmetto offers several examples, including the following:

Example 1: Suppose the patient receives 1,232 IU. You should divide 1,232 by 100. The result is 12.32. The nearest whole number is 12 (because .32 is less than .50). So you should report 12 units.

Example 2: Suppose the patient receives 25,778 IU. You should divide 25,778 by 100. The result is 257.78. The nearest whole number is 258 (because .78 falls into the range of .50 or higher). So you should report 258 units.

The MAC clarifies that the rule applies to the following codes, which are all defined "per i.u." or "per microgram": J7185-J7187, J7189-J7190, J7192-J7195, J7198, and Q2041. The rule does not apply to J7196 (Injection, antithrombin recombinant, 50 i.u.) or J7199 (Hemophilia clotting factor, not otherwise classified).