Primary Care Coding Alert

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

A new MLN Matters article, effective as of Jan. 1, alerts practices that CMS has extended intravenous immune globulin (IVIG) payment though 2008, but with a few slight changes.

Chief among the changes is the news that the previous IVIG codes (Q4087, Q4088, Q4091 and Q4092) have been deleted. 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, in Charlotte, N.C. Instead, Willis says, you should use the following codes:

- J1561 -- Injection, immune globulin (Gamunex), intravenous, nonlyophilized (e.g., liquid), 500 mg

- J1568 -- Injection, immune globulin (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg

- J1569 -- Injection, immune globulin (Gammagard liquid), intravenous, nonlyophilized (e.g., liquid), 500 mg

- J1572 -- Injection, immune globulin (Flebogamma), intravenous, nonlyophilized (e.g., liquid), 500 mg

- J1566 was revised this year to indicate "not otherwise specified" IVIG (for example, Carimune).

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, 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," she says.

Your coding will be complete once you add the appropriate administration code. For the physician's work infusing these drugs, you should still report 90765 (Intravenous infusion, for therapy, prophylaxis or diagnosis [specify substance or drug]; initial, up to one hour). If the infusion lasts more than one hour, add on code +90766 (... each additional hour [list separately in addition to code for primary procedure]).

Hidden trap: When coding for IVIG, stay away from 96413 (Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug) and +96415 (... each additional hour [list separately in addition to code for primary procedure]). These codes are intended for intravenous chemotherapy only.

Example: The FP administers 500 mg of Gamunex for a service that lasts less than an hour.

Solution: For this claim, you should report J1561, 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.

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.