Oncology & Hematology Coding Alert

Don't cheat yourself by underreporting units

If you code for the drugs you supply to patients, don't count on your 2006 job aids. HCPCS 2007 adds several new codes you can't afford to miss.

For oncology, some of the most important codes include the following, says Carolyn M. Davis Hutt, CMA, CPC, CCP, CCS-P, CPHT, RMC, reimbursement coordinator with Oncology Hematology West in Omaha, Neb., in her audioconference presentation -2007 Oncology Coding Update- for The Coding Institute:

- J0594 -- Injection, busulfan, 1 mg

- J0894 --Injection, decitabine, 1 mg

- J1562 -- Injection, immune globulin, subcutaneous, 100 mg

- J8650 -- Nabilone, oral, 1 mg

- J9261 -- Injection, nelarabine, 50 mg.

Tip: Code G0332 (Preadministration-related services for intravenous infusion of immunoglobulin, per infusion encounter) is still payable in 2007, so you should report it in addition to your IVIG administration and drug codes, Hutt says.

Prepare for Odd Amounts and Missed Doses

Red flag: According to the Medicare Claims Processing Manual Chapter 17, titled -Drugs and Biologicals,- 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 (HCPCS) code, the provider rounds to the next highest units in the HCPCS description for the code- (www.cms.hhs.gov/manuals/downloads/clm104c17.pdf, page 6).

Example: Oncologists use nelarabine (Arranon) to treat patients with T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma, who relapse or don't respond to at least two chemotherapy regimens. A 75-mg injection of nelarabine merits two units of J9261 because one unit equals 50 mg and you should round up to two units for the additional 25 mg administered.

The Manual also states that -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- (www.cms.hhs.gov/manuals/downloads/clm104c17.pdf, page 6).

Example: The physician provides less than 50 mg of nelarabine. Report one unit of J9261.

Caution: -If a patient does not show up for a procedure, you cannot charge for the pharmaceutical,- says Rehna Burge, billing analyst for North Oaks Medical Center in Hammond, La.

Use the -Missed-Appointment- Tactic

Some practices institute a -missed-appointment- fee that they bill directly to the patient.

Using such fees must be approved within the contract that your practice has with payers, and you must provide the patient with a copy of your missed-appointment policy in advance. Careful: Be sure your policy complies with state laws.

Resource: You can look at the 2007 HCPCS codes online at www.cms.hhs.gov/HCPCSReleaseCodeSets/.