Oncology & Hematology Coding Alert

Question: Which HCPCS and CPT codes are appropriate for MOPP?

Florida Subscriber

Answer: The MOPP (also called MVPP) combination chemotherapy regimen includes:

• M: Mechlorethamine (Mustargen)
• O: Vincristine (Oncovin or Vincasar)
• P: Procarbazine (Matulane)
• P: Prednisone.

You should report mechlorathemine using J9230 (Injection, mechlorethamine hydrochloride, [nitrogen mustard], 10 mg). Because it is an antineoplastic, you should report administration using the appropriate chemotherapy administration code(s) (96401-96549).

You should report vincristine using J9370 (Vincristine sulfate, 1 mg). Remember HCPCS 2011 deleted J9375 (Vincristine sulfate, 2 mg) and J9380 (Vincristine sulfate, 5 mg). Because vincristine is also a chemotherapy drug, you again should use the appropriate chemotherapy administration code(s) (96401-96549).

Don't report these drugs: Procarbazine and prednisone are given orally as part of the MOPP regimen. HCPCS offers S0182 (Procarbazine hydrochloride, oral, 50 mg) and J7506 (Prednisone, oral, per 5mg), but you should not report supply (HCPCS) or administration (CPT) codes for these drugs on your Part B claims. CMS does not cover "self-administered" drugs under Part B. (See Medicare Benefit Policy Manual, chapter 15, section 50.5, www.cms.gov/Manuals/IOM/list.asp.)

Exception: The provider may deem it necessary to administer the injectable form of prednisone, such as J1030 (Injection, methylprednisolone acetate, 40 mg). In that rare case, you may be able to code the drug and administration. Medicare Benefit Policy Manual, chapter 15, section 50.4.3, explains that Medicare doesn't cover a medication's injectable form if the oral route is standard and medically appropriate. But the manual indicates there could be an exception if special medical circumstances justify an injection rather than the oral form. If the injectable form is used, the provider should briefly document the reason why to help support your code choice.

Caution: Be sure to code based on the detailed documentation rather than from a protocol's abbreviation. For example, the oncologist may change the order based on white blood and platelet counts.