Oncology & Hematology Coding Alert

Question: How can we report when our physician administers 150 mg of rituximab?

New Mexico Subscriber

Answer: When reporting for rituximab injections, first step is to check the amount of rituximab mentioned on the vial or package label. Because the medication is a supplied in a single dose vial, Medicare pays for the drug “up to the amount” on the label if the entire vial isn’t used and had to be wasted.  Rituximab is available as 100 mg/10 mL and 500 mg/50 mL solution in single-use vials. If the physician administered 150 mg of rituximab, and used 2 vials of 10 mL, you submit 2 units of code J9310 (Injection, rituximab, 100 mg) as one unit equals 100 mg of rituximab.  It is important to responsibly order and stock medications in a package size which allows for the most efficient use and least wastage when administering the medication.  However, if the office only had a 500mg/50ml on the date of service, then 2 units would be billed for the amount given and 3 units for the wasted amount (if it was wasted) and not used on another patient.

Account for wastage: An important concept for clean rituximab claims is that you may report to Medicare the amount administered as well as the amount that is discarded because rituximab is available only as a single-use vials.  Medicare will reimburse for the full quantity of single-use vial for any amount that is wasted when it cannot be used on another patient.

Medicare’s exact language is: “When a physician, hospital or other provider or supplier must discard the remainder of a single use vial or other single use package after administering a dose/quantity of the drug or biological to a Medicare patient, the program provides payment for the amount of drug or biological discarded as well as the dose administered, up to the amount of the drug or biological as indicated on the vial or package label” Medicare Claims Processing Manual, Chapter 17, Section 40, at www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c17.pdf.

Keep documentation: Fortunately, you need not focus on how the wastage occurred. Just be sure that your physician has documented the amount administered and the amount wasted so both amounts can be reported.