Oncology & Hematology Coding Alert

Learn the new Q codes -- or risk losing more than $30 for each dose

If you haven't updated your charge tickets and software with the new intravenous immune globulin (IVIG) HCPCS codes, you could already be out of luck -- Medicare payers stopped accepting the old code as of July 1, 2007.

Old way: For services performed before July 1, report J1567 (Injection, immune globulin, intravenous, non-lyophilized [e.g., liquid], 500 mg) for the injection, says Melanie Kramer, CPC, coder for Bozeman Deaconess Hematology & Oncology Associates in Bozeman, Mont.

New way: CMS is implementing its plan to ensure accurate payment for single-source drugs (those with no therapeutic equivalent) and biologicals by using unique HCPCS codes. For services on or after July 1, Kramer says, you should report one of the following (shown with Medicare's payment amount limits through Sept. 30):

• Q4087 (Injection, immune globulin [Octagam], intravenous, non-lyophilized [e.g., liquid], 500 mg) -- $33.83 payment limit
• Q4088 (Injection, immune globulin [Gammagard liquid], intravenous, non- lyophilized [e.g., liquid], 500 mg) -- $31.19 payment limit
• Q4091 (Injection, immune globulin [Flebogamma], intravenous, non-lyophilized [e.g., liquid], 500 mg) -- $32.61 payment limit
• Q4092 (Injection, immune globulin [Gamunex], intravenous, non-lyophilized [e.g., liquid], 500 mg) -- $31.86 payment limit.

Medicare has also provided two new codes for use on or after July 1:

• Q4089 (Injection, Rho[D] immune globulin [human], [Rhophylac], intramuscular or intravenous, 100 iu) -- $5.33 payment limit
• Q4090 (Injection, hepatitis B immune globulin [HepaGam B], intramuscular, 0.5 ml) -- $64.73 payment limit.

Watch for: Rhophylac is the only product you should report using Q4089, says Medicare in MLN Matters article MM5635. And be sure you only report Q4090 for HepaGam delivered with an intramuscular injection. -HepaGam B when given intravenously should be billed using an appropriate Not Otherwise Classified code in the absence of a specific HCPCS code,- Medicare says.

Be sure to check with your non-Medicare payers -- some may still require you to report J1567, even after July 1.

Don't Forget Admin, Pre-Admin Codes

For the oncologist's work in infusing these drugs, you still should report 90765 (Intravenous infusion, for therapy, prophylaxis or diagnosis [specify substance or drug]; initial, up to one hour).

Add on +90766 (... each additional hour [list separately in addition to code for primary procedure) if the infusion lasts more than one hour.

Exception: For HepaGam injections, report 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) along with Q4090, says oncology coding expert Cindy Parman, CPC, CPC-H, RCC, co-founder of Coding Strategies Inc. in Powder Springs, Ga. Why: Code 90772 describes an intramuscular injection, as opposed to IV infusion.

Hidden trap: Stay away from 96413 (Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug) and +96415 (... each additional hour) when coding for IVIG. Those codes are intended for IV chemotherapy only.

Medicare will continue to reimburse G0332 (Services for intravenous infusion of immunoglobulin prior to administration [this service is to be billed in conjunction with administration of immunoglobulin]) for IVIG pre-administration. Report it alongside Q4087, Q4088, Q4091 or Q4092. Only report one pre-admin service per day per patient.

Learn more: Read Medicare's official immune globulin instruction in CR5635 at www.cms.hhs.gov/Transmittals/downloads/R1261CP.pdf (Transmittal 1261 of the Medicare Claims Processing Manual).

You can find a summary in MLN Matters article MM5635, -Revised HCPCS Codes Relating to Immune Globulin- at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5635.pdf.