Oncology & Hematology Coding Alert

Question: How should I code 32 mg of premixed Zofran in a single-dose container?


Tennessee Subscriber

Answer: Even though the injection material is premixed, you should still report it with J2405 (Injection, ondansetron HCl, per 1 mg). You should report 32 units, according to Cigna, the Part B carrier for Tennessee.
 
If the physician administers the Zofran orally, you should instead report Q0179 (Ondansetron HCl 8 mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen).

Your payer may have specific rules for reimbursement. Cigna requires documentation of attempts to use less expensive agents and the oral form of Zofran before the physician prescribes Zofran. (See www.cignamedicare.com/partb/bltin/all/97bltin/1997/Gr97-6/tn/zofran_usage.html for more information.)