Oncology & Hematology Coding Alert

Question: How should I code for the PO administration of dolasetron (Anzemet)?

Virginia Subscriber

Answer: Medicare covers oral anti-emetic drugs when they are used as full replacements for intravenous anti-emetic drugs as part of a cancer chemotherapeutic regimen. CMS has issued very specific payment guidelines for this, which were revised most recently effective Oct. 1, 2000. This revision states that "under all circumstances all oral anti-cancer drugs and all oral anti-emetic drugs must be submitted to DMERCs (durable medical equipment regional carriers) for payment." Carriers will no longer accept these claims for payment. Your practice must have a DMERC billing number to bill for oral medications.

Coverage guidelines state that Medicare will pay for oral anti-emetic drugs when used as full therapeutic replacement for intravenous dosage forms as part of a cancer chemotherapeutic regimen when the drug(s) is administered or prescribed by a physician for use immediately before, at, or within 48 hours after the time of administration of the chemotherapeutic agent. The allowable period of covered therapy includes day one, the date of service of the chemotherapy drug (beginning at the time of treatment), plus a period not to exceed two additional calendar days, or a maximum period up to 48 hours. The oral anti-emetic drug(s) should be prescribed only on a per-chemotherapy-treatment basis. These drugs may be supplied by the physician in the office or through a supplier, e.g., a pharmacy.

In order for the oral anti-emetic drugs to be covered by Medicare, the physician must indicate on the prescription that the beneficiary is receiving the oral antiemetic drug(s) as full therapeutic replacement for an intravenous anti-emetic drug as part of a cancer chemotherapeutic regimen. This will indicate to the supplier of the drug(s) that the claim should be submitted using a Q code. The code for Anzemet is Q0180 and is described by Medicare as "dolasetron mesylate 100 mg., oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 24-hour dosage regimen."