Oncology & Hematology Coding Alert

Question: A Medicare patient was referred to us for an injection of Neupogen (J1441) and Leukine (J2820) on the same day, with a diagnosis of neutropenia. Can we get paid for both drugs?

Florida Subscriber

Answer: You may bill separately for the same-day usage of Neupogen and Leukine because Medicare guidelines do not specifically prohibit two drugs to be injected on the same day.
 
Absent any specific Medicare guidelines that prohibit or condone such a billing practice, leave the final approval with individual carriers. The need to show medical necessity for using both drugs on the same day becomes a heightened responsibility for oncology practices.
 
Neutropenia is an abnormally low level of neutrophils (white blood cells) and is a serious disorder because it makes the body vulnerable to bacterial and fungal infections. One of the causes is chemotherapy drugs. Neupogen and Leukine can be used to treat it and ward off infections.
 
Neupogen, which is blood line-specific, stimulates the growth of neutrophils only. Leukine has a broader span of activity, stimulating more than one blood cell line. Leukine can also stimulate platelet and red blood cell production. Because of the broader span of activity, Leukine is most commonly used after bone marrow transplantation (38240-38241), before and after peripheral blood stem cell transplantation (38240-38241), and following induction chemotherapy in older patients with acute myelogenous leukemia (205.0) 
 
Documentation of medical necessity should include 205.0 to show that Leukine was used as indicated. Code 288.0 should also be listed to indicate that the patient suffers from neutropenia.
 
If Medicare denies the claim, appeal it and cite reported diagnosis codes and manufacturers' indications as documentation to prove the reasoning behind the administration of both drugs on the same day.