Ondansetron Update: Q0162 Takes the Place of Q0179 in 2012 (January 2012)
Tap these resources on Medicare’s oral anti-emetic policy.If your practice reports oral anti-emetics, be sure you’re up on the latest ondansetron coding news or you could start seeing denials.This drug received a new HCPCS code, effective Jan. 1, 2012: Q0162 (Ondansetron 1 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen).To make room [...]
J8561: Afinitor and Zortress Have a Common Code (January 2012)
As an oncology coder, you may be interested to know that HCPCS 2012 added J8561 (Everolimus, oral, 0.25 mg), which applies to Afinitor and Zortress. Afinitor is used to treat advanced renal cell carcinoma (RCC) previously treated unsuccessfully with other medications and to treat the brain tumor subependymal giant cell astrocytoma (SEGA) when surgery isn’t an option for patients with tuberous sclerosis.Physicians prescribe Zortress with other medications to prevent transplant rejection.Key point: This code is [...]
HCPCS Update: J1561’s New Look Reveals Trade Name and Admin Modifications (January 2012)
Plus: Check out more new codes for pain and fracture prevention.Changes to acetaminophen, denosumab, and immune globulin coding are sure to keep you on your toes in 2012. Keep a close eye on the administration methods for Ofirmev and Gamunex-C, in particular.J0131: Add a New Acetaminophen CodeHCPCS 2012 adds a code for acetaminophen administered by infusion: J0131 (Injection, acetaminophen, 10 mg). The brand name for this injectable form is Ofirmev. Physicians may order the drug [...]
ICD-10-CM: V58.11 Finds Its Match in Z51.11 (January 2012)
Immunotherapy finds a similarly clear counterpart in the new code set.The ICD-9-CM code for a chemotherapy encounter, V58.11, may be one of your most used codes. But when ICD-10-CM becomes your new diagnosis code set in 2013, you’ll have a new top code. Here are a few tips to help ease the way.ICD-9-CM: Under ICD-9-CM 2012, your first-listed code when a patient presents solely for antineoplastic chemotherapy is V58.11 (Encounter for antineoplastic chemotherapy).You choose a [...]
Clotting Factor Update: J7180 and J7183 Bring New Options for Corifact and Wilate (January 2012)
Say so long to J7184 and Q2041.Double check the 2012 HCPCS codes before you report hemophilia clotting factors provided Jan. 1, 2012, or later.Corifact: HCPCS 2012 adds J7180 (Injection, factor XIII [antihemophilic factor, human], 1 I.U.). The request for the new code was made with Corifact in mind, according to the May 17, 2011, HCPCS Public Meeting Agenda (www.cms.gov/MedHCPCSGenInfo/downloads/Tues_May17thDrug-Agenda.pdf). In patients with congenital factor XIII deficiency, Corifact “is used to replace the missing Factor XIII [...]
For accurate claims, distinguish these professionals from ‘clinical staff.’The definition of “other qualified health care professional” didn’t make it into the CPT® 2012 manual, but you need to know and apply this definition all the same. The AMA lists the definition as part of the “CPT® 2012 Errata” on its website (www.ama-assn.org/resources/doc/cpt/cpt-corrections.pdf). The definition is as follows:“A ‘physician or other qualified health care professional’ is an individual who is qualified by education, training, licensure/regulation (when [...]
You Be the Coder: Are 3 Drugs in 1 Bag Concurrent? (January 2012)
Question: The patient presents for chemotherapy (57-minute infusion). Staff mixed three non-chemo drugs in a single bag and administered them during a 45-minute infusion prior to chemotherapy. How should I code this? I’m confused about whether I should report concurrent infusion code +96368. California SubscriberAnswer: Your “initial” code for this case should be 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug). This code describes up to an hour of [...]
Reader Question: G0364 or 38220 Depends on Payer (January 2012)
Question: For private payers, should I report G0364 or 38220 for aspiration and biopsy at the same session?Illinois SubscriberAnswer: As is so often the case, you should get your payer’s preference in writing and follow that instruction for that payer. In general terms, when the physician performs a bone marrow aspiration and biopsy at the same site during the same session, you should report 38221 (Bone marrow; biopsy, needle or trocar) for the biopsy. For [...]
Reader Question: 96372 Represents Office EpiPen Injection (January 2012)
Question: We used the EpiPen kit in the office on a patient who experienced an allergic reaction. How do we bill for using the kit?Vermont SubscriberAnswer: Use of an EpiPen represents an injection of epinephrine. As such, it would be appropriate to code its administration using code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).The preferred HCPCS code may vary by payer, with some preferring J0171 (Injection, adrenalin, epinephrine, 0.1 mg) and [...]
Reader Question: 280.x Lands on List for Iron Therapy NCD (January 2012)
Question: When a national coverage determination doesn’t specify which codes to use, how do we know which particular codes apply?Nevada SubscriberAnswer: When a national coverage determination (NCD) doesn’t list specific codes for use, your next step should be to check for a local coverage determination (LCD) or local payer policy.For example: Palmetto GBA offers a list titled “J1 A/B MAC Palmetto GBA Assigned ICD-9-CM Codes for National Coverage Determinations.” It doesn’t supply codes for all [...]
