Oncology & Hematology Coding Alert

Question: I have a question regarding the administration of Fludara 50 mg (J9185). At our practice, we frequently need to give the patient only 25 mg. Can bill Medicare for full price, or do I need to cut the price down for a partial dose?

Massachusetts Subscriber

Answer: J9185 is the appropriate J code to use for fludarabine phosphate (Fludara). Carriers have discretion in how they reimburse for this agent, so it is best to check with your carrier. As a rule, if a drug is supplied in a single-use e.g., 50 mg, and the patient is ordered 25 mg, one 50-mg vial is used with 25 mg given to the patient and the remainder billed as waste. You must discard the remaining drug - it cannot be used on another patient.

Also, you should ask your carriers what documentation they require. Some carriers require the actual dose given to be entered on the claim form. Regardless of the individual requirements for claim-form submission by your carrier, you need to make sure that on the patient's chart the actual dose given and the amount of drug wasted are clearly documented.

- Answers to the Reader Questions and You Be the Coder were provided by Elaine Towle, CMPE, practice administrator for New Hampshire Oncology and Hematology in Hooksett; and Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans.