Oncology & Hematology Coding Alert

Question: Our physician recently administered 146 mg of Eloxatin to help treat a patient’s colorectal cancer. What is the correct way to code this amount of the drug?

Florida Subscriber

Answer: Eloxatin is a brand name for oxaliplatin, an alkylating antineoplastic drug used to treat advanced cancers of the bowel, colon, or rectum.

The HCPCS code for oxaliplatin is J9263 (Injection, oxaliplatin, 0.5 mg), which, as the descriptor notes, is coded in 0.5 mg increments. As the amount the patient received is not an increment of the amount in the code descriptor, you would divide the strength given by 1 unit of the drug HCPCS code. Therefore you would calculate 146/0.5 = 292 units.

So, in your scenario, you would bill 292 units of J9263 for the 146 mg given.

As oxaliplatin is normally supplied in single dose vials of 50 mg or 100 mg, chances are your physician used two vials totaling 150 mg for the patient’s treatment. As you are reporting 146 mg administered to the patient, if the provider discards the remaining amount of the drug in the vials and documents the wasted amount, you may also report and be paid for the amount of the wasted medication. You will report the 4 mg (which equates to 8 units of J9263, or 1 unit for each 0.5 mg) of the drug wasted on a second line of the claim with modifier JW (Drug amount discarded/not administered to any patient).

So, in order to bill and reimburse for the treatment, you should document the following in the patient’s record and on the claim in this way:

1. J9263 x 292
2. J9263-JW x 8