HCPCS Update: J9043 Leads the Pack of New Chemotherapy Codes for 2012   (December 2011)

The 2012 examples show which new drug code you’re likely to pair with a push admin code.HCPCS has three all new J9xxx codes available for 2012 dates of service. Jevtana, Halaven, and Yervoy all now have specific codes you can report when your practice supplies those drugs.How to prepare? Be sure to update your charge master, electronic dictionaries, and charge slips to reflect any code and/or unit changes. “It is also a good idea to [...]

HCPCS Tip: Make the Most of Medicare’s Unit Calculation Rules   (December 2011)

While you’re reviewing HCPCS 2012 updates with your practice, take a moment to go over Medicare’s policy on calculating units. Reporting units correctly is crucial to accurate claims and appropriate reimbursement.You’ll find helpful instructions in the Medicare Claims Processing Manual, 100-04, chapter 17, section 70 (www.cms.gov/manuals/downloads/clm104c17.pdf). Example: Among the rules and examples, you’ll find the important instruction that “When the dosage amount is greater than the amount indicated for the HCPCS code, the facility rounds [...]

Table: Q0179 Is Out, Q0162 Is In for 2012   (December 2011)

See non-chemotherapy HCPCS changes at-a-glance.Whether your practice supplies Xgeva, Gamunex-C, or Zuplenz, HCPCS 2012 has important changes you can’t afford to miss.Review the updates to the non-chemotherapy codes you’re most likely to use, listed in the table below. Check the next issue of Oncology & Hematology Coding Alert for a detailed look at these code changes, which are effective Jan. 1, 2012.

CPT® 2012: 38230 and 38231 Will Require Knowledge of Bone Marrow Donor   (December 2011)

Change to global days offers new option for E/M reporting.Prepare to track down some donor details before you code bone marrow harvesting. CPT® 2012 wants to know.For 2011 dates of service, if someone had asked, “Does coding for bone marrow harvesting differ based on whether the patient donates the cells or whether another person donates the cells?” the answer would have been, “No.”But a code revision and a code addition in CPT® 2012 change that [...]

Provenge: Q2043 No Longer Includes Admin — Claim Your $71   (December 2011)

Don’t miss the effective date for this change.Medicare offered some positive news for practices providing Provenge. The administration is now separately billable.History: In Transmittal 2254, dated July 8, 2011, CMS announced that Q2043 (Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion) included all related services. The transmittal specifically listed administration as not separately billable.But a new transmittal changes all that by stating that [...]

Breast Cancer: J9035: CMS Avastin Coverage Is Safe for Now   (December 2011)

Brush up on Medicare’s off-label drug use policy.If you’re worried that the FDA’s decision to withdraw approval of Avastin for breast cancer treatment means Medicare will stop covering the drug for your patients with breast cancer, take heart.“Medicare will continue to cover Avastin,” said CMS spokesman Don McLeod in a statement. “CMS will monitor the issue and evaluate coverage options as a result of action by the FDA but has no immediate plans to change [...]

ICD-10-CM: C64.- Will Require More Detail than Your Current Kidney Neoplasm Code   (December 2011)

But you’ll still need to look elsewhere to report renal pelvis neoplasms.When ICD-10-CM replaces ICD-9-CM on Oct. 1, 2013, you’ll be stuck reporting a lot of “unspecified” codes if your practice doesn’t have its documentation ducks in a row. That’s because many of the ICD-10-CM codes require more anatomic location information than ICD-9-CM codes currently do. As an example, take a look at the codes for kidney malignant neoplasms.ICD-9-CM: Under ICD-9-CM, you should report a [...]

You Be the Coder: 36593 on Chemo Day: Yes or No?   (December 2011)

Question: I know I can’t report vascular access device flushing on the same date as chemotherapy, but what if the staff uses tPA to declot a vascular device? May I report that service separately? How should I code multiple injections? California SubscriberAnswer: You may report the vascular device declotting using tPA (tissue plasminogen activator) on the same date as chemotherapy administration. For the declotting service, you should report 36593 (Declotting by thrombolytic agent of implanted [...]

Reader Question: J3300 and J3301 Both Connect to Kenalog Injection   (December 2011)

Question:  How should I report an injection of Kenalog?South Carolina SubscriberAnswer:  Report 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the injection. Then, use J3300 (Injection, triamcinolone acetonide, preservative free, 1 mg) or J3301 (Injection, triamcinolone acetonide, not otherwise specified, 10 mg) for the Kenalog itself. Pay careful attention to the code descriptors when reporting units. For J3300, you should report 1 unit per 1 mg. In contrast, you [...]

Reader Question: 182.0 Describes ESS   (December 2011)

Question: How should I report endometrial stromal sarcoma?Nevada SubscriberAnswer: The correct ICD-9-CM code is 182.0 (Malignant neoplasm of body of uterus; corpus uteri, except isthmus). The inclusion note for 182.0 lists endometrium (uterine lining), as well as cornu (uterine horn where fallopian tube connects), fundus (top portion opposite the cervix), and myometrium (muscular wall of the uterus).Endometrial stromal sarcoma (ESS) is a rare form of uterine sarcoma affecting the supporting tissue of the endometrium.