Oncology & Hematology Coding Alert

Question: One of our patients is receiving Topotecan (J9350), 1.8 mg per day for five days. The vial comes in 4-mg portions. I don't want to throw the unused portion away because the drug is good for 24 hours and can be used for the same patient the next day. The way I see it, it would be more efficient to administer two doses out of the same vial and not waste the rest of the vial. The J code for this drug is measured in 4-mg units, and reimbursement is based on that amount. How should I bill for this patient?

New Mexico Subscriber

Answer: If the Topotecan (or other drug) is a single-use vial, you shouldn't reuse it; rather, you should bill for the full vial. If you can safely use the vial more than once for the same patient, the definition of the billable unit dictates that you would have to bill it all under one person and document clearly in both daily charts that this is a single vial split over two days. It will take some follow-up to make sure that you do not inadvertently bill the procedure again the next day.

Answers to the Reader Questions and You Be the Coder were provided by

Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans; Melody W. Mulaik, MSHS, CPC, RCC, president and co-founder of Coding Strategies Inc. in Atlanta; and Elaine Towle, CMPE, practice administrator for New Hampshire Oncology and Hematology in Hooksett.