Oncology & Hematology Coding Alert

Radiopharmaceuticals get a makeover in 2006

Locate your HCPCS manual before coding radiopharmaceutical use in 2006. Effective Jan. 1, you report Zevalin with a code that's more in tune with how your practice buys and uses the agent.

Hunt Down New Zevalin HCPCS

Here's a breakdown of the Zevalin coding changes you need to know:

Diagnostic: Oncologists may use Zevalin as a diagnostic tool to locate a tumor.

- 2005 method: You reported A9522 (Supply of radiopharmaceutical diagnostic imaging agent, indium 111 ibritumomab tiuxetan, per mci) for physicians or C1082 (Supply of radiopharmaceutical diagnostic imaging agent, indium 111 ibritumomab tiuxetan, per dose) for hospitals.

- 2006 method: Report A9542 (Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries). Experts predict that you will use A9542 for both physician and hospital coding.
 
Therapeutic: The oncologist may deliver Zevalin through monoclonal antibody therapy.

- 2005 method: You reported A9523 (Supply of radiopharmaceutical therapeutic imaging agent, yttrium 90 ibritumomab tiuxetan, per mci) for physicians or C1083 (Supply of radiopharmaceutical therapeutic imaging agent, yttrium 90 ibritumomab tiuxetan, per dose) for hospitals.

- 2006 method: Report A9543 (Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries). Again, experts predict A9543 will be available to both physician and hospital coders
 
Rationale: -Providers often purchase and administer radiopharmaceuticals not by the number of millicuries or microcuries but by the dose,- says Denise A. Merlino, MBA, CNMT, FSNMTS, coding adviser for the Society of Nuclear Medicine.

Now both physician and hospital coders will be able to report the radiopharmaceuticals per dose.

Action plan: The radiopharmaceutical changes mean that you need to make sure you-re using these new codes for services performed on or after Jan. 1, 2006. You also need to watch the number of units you report. In 2005, coders for physicians and freestanding offices reported these codes per millicurie.

In 2006, report each dose as one unit, up to the specified amount.

Resource: You can find the full list of HCPCS codes on the CMS Web site at www.cms.hhs.gov/providers/pufdownload/anhcpcdl.asp.

Dazzle Payers With Diagnostic Service Coding

Oncologists may use localization to determine whether a radiopharmaceutical will target a patient's tumor or will concentrate in critical organs, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga.

Local carriers may have their own preferences for coding Zevalin use, so you should always check your policy for the proper codes. General rule: You typically report 78804 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; whole body, requiring two or more days imaging) when the oncologist localizes a tumor or distributes Zevalin throughout the whole body. You should report the Zevalin used with A9542.

Watch for: The descriptor for 78804 includes the phrase -requiring two or more days imaging.- This means that although the oncologist may perform multiple days of radiopharmaceutical testing, you should only report code 78804 once.

Why: The study involves two--or, in rare cases, three--sets of whole-body gamma camera images within the days following the distribution of the agent. The oncologist provides review and oversight during the entire study and supervises a slow infusion of the antibody, watching for reactions. After the second or third set of images, the oncologist compares the images taken during this lengthy study, which is why you should only report 78804 once, Parman says.

Note: If the physician acquires the images on a single day, look to 78802 (- whole body, single day imaging) instead of 78804.

Documentation tip: Include the complete interpretation and report, which should record who performed the injection or infusion and how long the study took.

Reel in Radiopharmaceutical Therapy Revenue

Oncologists may choose to treat non-Hodgkin's lymphoma patients with Zevalin through monoclonal antibody therapy. Watch out: Many payers have strict guidelines about when they-ll cover Zevalin therapy. Many won't reimburse you if the oncologist chooses Zevalin as a -first line- therapy.

How to code: Report the therapeutic portion of the service with 79403 (Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion). Report the Zevalin with A9543.

Oncologists may use Zevalin along with the chemo drug Rituxan (J9310, Rituximab, 100 mg) for non-Hodgkin's lymphoma patients who haven't responded to other chemotherapy or who have relapsed. The HCPCS code for Rituxan is the same in 2006 as it was in 2005.

Caution: Check your payer guidelines--many won't allow you to report an administration code for Zevalin, considering administration inherent to the service.