Oncology & Hematology Coding Alert

Question: We are treating a Medicare patient who is in replacement therapy for hemophagocytic lymphohistiocytosis. Our oncologist administered 30 mg of Octagam. I-m trying to find the correct J code for this substance. My HCPCS book shows J1563, but when I look on the Medicare Part B allowable for April-June 2008, this code is not there. What is the right J code for Octagam?

Missouri Subscriber

Answer: You-re on the right track, but you may be using an out-of-date HCPCS copy. This drug received a new J code, which appears in HCPCS 2008 -- J1568 (Injection, immune globulin [Octagam], intravenous, nonlyophilized [e.g., liquid], 500 mg).

The April ASP file from Medicare also lists this new code, noting that it carries a potential reimbursement amount of $34.069. You can find the full list on the CMS Web site at http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a_2008aspfiles.asp#TopOfPage.

What happened to J1563: The J codes used for reporting immune globulin injections were reclassified as Q codes in 2007. HCPCS 2008 moved several of these codes from the Q category into the J section, meaning that the drugs described by the temporary codes now have permanent code status.

Additional info: To code for the patient's hemophagocytic lymphohistiocytosis (HLH), a primary immunodeficiency disease, your correct choice will be 288.4 (Hemophagocytic syndromes).

-- The answers for You Be the Coder and Reader Questions were reviewed 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.