Oncology & Hematology Coding Alert

Question: We-re having a dispute in our office about reporting Herceptin. Should I report it as a single-dose or multi-dose vial?

California Subscriber

Answer: You should not consider Herceptin to be a single-dose vial drug.

Here's why: You purchase Herceptin (J9355, Trastuzumab, 10 mg) as a 440 mg multi-dose vial. The staff reconstitutes it with bacteriostatic water that includes a preservative, allowing you to keep (and use) the remaining portion for 28 days.

Why it matters: Medicare reimburses you for the discarded portion of a single-dose vial but not the discarded portion of a multi-use vial, according to Medicare Claims Processing Manual, chapter 17, section 40 (www.cms.hhs.gov/manuals/downloads/clm104c17.pdf).

Possible source of confusion: In many foreign countries, providers reconstitute the Herceptin without preservatives. They must discard the unused portion on the same day, and so these countries have available a 150 mg single-dose vial.

 -- Technical and coding advice for You Be the Coder and Reader Questions provided by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and past-president of the American Academy of Professional Coders National Advisory Board.