Oncology & Hematology Coding Alert

Myth: You should report the appropriate Q code (such as Q4087) for your physician's immune globulin injections, add your corresponding administration code, and your claim is ready to go.

Reality: If you haven't noticed the new HCPCS code changes for immune globulin injections yet, keep in mind that your carrier certainly has -- and will reject claims that use the now-deleted Q series.

A new MLN Matters article, which went into effect Jan. 1, alerts practices that CMS has extended intravenous immune globulin (IVIG) payment though 2008 but with a few changes.

Chief among the changes is the news that HCPCS deleted the previous IVIG codes (Q4087, Q4088, Q4091 and Q4092). This code series went into effect last July, so some practices may still be cutting their teeth on these Q codes. But as Medicare has been known to do before, carriers will now deny these codes for dates of service on or after Jan. 1, 2008.

"Immune globulin is now more specific by drug name," says Toscha S. Willis, CPC, coder with Piedmont Oncology Specialists II PLLC in Charlotte, N.C. Instead, you should use the following codes, Willis says:

- J1561 -- Gamunex, 500 mg, liquid

- J1562 -- Vivaglobin, 100 mg

- J1568 -- Octagam, 500 mg, liquid

- J1569 -- Gammagard, 500 mg, liquid

- J1572 -- Flebogamma, 500 mg, liquid

- J1566 -- Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg.

J1566 note: HCPCS revised this code this year to indicate "unspecified" IVIG or Carimune.

And J1566 is the only code for the "powder" IVIG, says Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga..

Medicare will continue to reimburse you for G0332 (Services for intravenous infusion of immunoglobulin prior to administration [this service is to be billed in conjunction with administration of immunoglobulin]) to describe the physician's IVIG pre-administration.

"You can bill this code in addition to the infusion and drug codes," says Tiffany Spencer, CPC, ACS-EM, a senior coding and billing consultant from North Carolina. "It is for obtaining the IVIG since there is such a shortage. Medicare reimburses approximately $60-$70 for the code."

Your coding will be complete once you add the appropriate administration code. For the physician's work infusing these drugs, you still should report 90765 (Intravenous infusion, for therapy, prophylaxis or diagnosis; initial, up to one hour). Add on code +90766 (... each additional hour) if the infusion lasts more than one hour.

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.

Example: The physician administers 100 mg of Vivaglobin for a service that lasts less than an hour.

Solution: For this claim, you should report J1562, G0332 and 90765, along with the appropriate ICD-9 code.

The MLN Matters article also reminds you to bill only one IVIG pre-administration code "per patient per day of IVIG administration" and that carriers will deny claims as unprocessable if they don't include G0332 along with the drug's J code.

Learn more: To read the full text of the MLN Matters article, visit the CMS Web site at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5713.pdf.

Note: For more information on the new IVIG codes, see "Find New HCPCS Codes Fast With This Handy Chart" in Vol. 10, No. 2 of Oncology & Hematology Coding Alert.