Oncology & Hematology Coding Alert

Question: I just saw that there will be a new VWF HCPCS code in July. Does the fact that it's a Q code instead of a J code like the other VWF codes mean anything for coding?

Illinois Subscriber

Answer: Whether a code starts with a J or a Q should not affect your coding, as long as the payer accepts Q codes. The difference between the two is that a Q code is a temporary code created by Medicare. If a decision is made to create a permanent code for the supply, service, or drug involved, then the Q code will be deleted when the new code is added.

Q2041: The new Q code you reference, effective July 1, 2011, is Q2041 (Injection, von Willebrand factor complex [human], Wilate, 1 I.U. VWF:RCO). Wilate is the trade name for a coagulant used for patients with the coagulating disorder von Willebrand disease (VWD). If a decision is made to create a permanent code for this VWF complex, it will likely be near the other VWF and antihemophilic factors, J7186-J7199.

In the works: A petition was made for a Wilate code reported per IU to match other VWF codes. The requestor claims that CMS's change from paying the clotting factor furnishing fee per IU to paying per unit created a reimbursement disadvantage for Wilate with its one unit per 100 IU code, J7184 (Injection, von Willebrand factor complex [human], Wilate, per 100 IU VWF:RCO). The change was announced in CR 6811, Transmittal 1908, available at www.cms.gov/transmittals/downloads/R1908CP.pdf.

As you can see, new code Q2041 is reported per IU, solving the problem. CMS's preliminary decision is to discontinue J7184 on Dec. 31, 2011, and establish a new J code for Wilate, reportable per IU, effective in January. Code J7184's status will change July 1 so that it is not payable by Medicare.

To read more about the HCPCS codes introduced for July 1, 2011, visit www.cms.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp. To read about proposed codes, visit www.cms.gov/MedHCPCSGenInfo/08_HCPCSPublicMeetings.asp and click on the 2011 meeting agenda links.