Oncology & Hematology Coding Alert

Question: I recently started working at a multispecialty practice that administers zoledronic acid for certain patients. What HCPCS code should I use to report this?

Delaware Subscriber

Answer: The answer depends on whether the doctor prescribes Reclast or Zometa. Oncologists typically prescribe Zometa, but especially if you-re in a multispecialty practice, you should stay alert to the drug used so that you choose the appropriate code.

Zometa: For products under the FDA's Zometa approval, report J3487 (Injection, zoledronic acid, 1 mg).

Reclast: For Reclast (or future products that fall under its FDA approval), report Q4095 (Injection, zoledronic acid [Reclast], 1 mg), effective July 1.

Oncologists typically use zoledronic acid for patients with multiple myeloma (203.0x, Multiple myeloma) or certain bone metastases (198.5, Secondary malignant neoplasm of other specified sites; bone and bone marrow).

Change rationale: As with the immune globulin coding changes discussed in "Apply This IVIG Change July 1," the zoledronic acid changes 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.

Resources: You-ll find the CMS transmittal on the new Reclast code at www.cms.hhs.gov/transmittals/downloads/R1260CP.pdf (Transmittal 1260, Medicare Claims Processing Manual, "July 2007 Quarterly Update to the HCPCS Codes for Albuterol, Levalbuterol, and Reclast").

For a summary, see MLN Matters MM5645 at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5645.pdf.

-- 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.