Oncology & Hematology Coding Alert
Round Up When Coding 75-mg Arranon Dose
Question: Our oncologist is treating a patient with T-cell lymphoblastic lymphoma. The patient didn't respond to two chemotherapy regimens. The physician administered a 75-mg injection of nelarabine. How should I code for the drug the provider administered? Louisiana Subscriber Answer: You-ll code for the 75 mg of nelarabine (Arranon) as two units of J9261 (Injection, nelarabine, 50 mg). One unit equals 50 mg, and you should round up to two units for the additional 25 mg administered. Note: If the physician provides 50 mg or less of nelarabine, you should only report one unit of J9261. According to Chapter 17 of the Medicare Claims Processing Manual, "if the full dosage provided is less than the dosage for the code specifying the minimum dosage for the drug, the provider reports the code for the minimum dosage amount." The Manual also notes that you should bill drugs "in multiples of the dosage specified in the HCPCS/NDC. If the dosage given is not a multiple of the Health Insurance Common Procedure Coding System code, the provider rounds to the next highest units in the HCPCS description for the code." More information: You can download the full text of Chapter 17 "Drugs and Biologicals" beginning on page 6 on the CMS Web site at http://www.cms.hhs.gov/manuals/downloads/clm104c17.pdf.
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