Oncology & Hematology Coding Alert

Question: I-ve been reporting J1567 for immune globulin. Is this correct for Medicare?

Ohio Subscriber

Answer: As of July 1, Medicare no longer pays J1567 (Injection, immune globulin, intravenous, non-lyophilized [e.g., liquid], 500 mg).

Instead: You should report the appropriate code from the following choices for Medicare patients:

- Q4087 -- Injection, immune globulin (Octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg

- Q4088 -- Injection, immune globulin (Gammagard  liquid), intravenous, non-lyophilized (e.g., liquid),  500 mg

- Q4089 -- Injection, Rho(D) immune globulin (human), (Rhophylac), intramuscular or intravenous, 100 iu

- Q4090 -- Injection, hepatitis B immune globulin (HepaGam B), intramuscular, 0.5 ml

- Q4091 -- Injection, immune globulin (Flebogamma), intravenous, non-lyophilized (e.g., liquid), 500 mg

- Q4092 -- Injection, immune globulin (Gamunex), intravenous, non-lyophilized (e.g., liquid), 500 mg.

Note: Codes Q4089 and Q4090 are new codes. For now, you should use them only to report the specific products in their descriptors: Rhophylac for Q4089 and HepaGam B for Q4090. If in the future new products become available under the FDA's Rhophylac approval, you-ll use Q4089 for those products. And if new products become available under the FDA's HepaGam B approval, you-ll use Q4090 for those.

Don't miss: You should report Q4090 only for intramuscular administration.

Report intravenous administration using an appropriate "not otherwise classified" code.

Medicare will continue to reimburse G0332 (Services for intravenous infusion of immunoglobulin prior to administration [this service is to be billed in conjunction with administration of immunoglobulin]) for intravenous immune globulin (IVIG) administration. Report it alongside Q4087, Q4088, Q4091 or Q4092.

Change rationale: The new codes are part of CMS- plan to ensure accurate payment for single-source drugs (those with no therapeutic equivalent) and biologicals by using unique HCPCS codes.

Remember: Non-Medicare payers may still require you to report J1567, so ask them to be sure.

Resources: Check out Medicare's official immune globulin instruction by going to CR5635 at www.cms.hhs.gov/Transmittals/downloads/R1261CP.pdf (Transmittal 1261 of the Medicare Claims Processing Manual). You can find a summary in MLN Matters article MM5635, "Revised HCPCS Codes Relating to Immune Globulin" at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5635.pdf.