Urology Coding Alert

Question: We've started using Plenaxis, which was just approved by the FDA last November, to treat patients with prostate cancer, but there's no code for it yet. How should we code for these injections, and what documentation do we need?

Tennessee Subscriber Answer: For Plenaxis (abarelix), report HCPCS code J9999 (NOC, antineoplastic drug) and link it to ICD-9 code 185 (Malignant neoplasm of prostate). Many carriers, including Cigna in Tennessee and North Carolina and TrailBlazer in Delaware, Maryland, Texas, Virginia and Washington, D.C., are allowing $897.18 ($852.32 non-par) for each 100 mg of the drug.

If you're using a paper claim, put a description of the drug and its National Drug Code - 68158-0149-51 - in box 19 of the 1500 form. For an electronic claim, put that information in the notepad. After August 1, 2004, urologists can purchase Plenaxis at a reduced cost of $708 per injection.

Don't miss: The FDA requires that the urologist sign an attestation before providing the drug; your carrier will probably check to make sure you have that. You can download the physician attestation, along with the full prescribing information and an informed consent form for the patient, at www.plenaxis.com.