Oncology Billing Toolkit: Factor 8 HCPCS Changes Into Your Superbill

Watch those Taxotere units, or kiss 95 percent of your reimbursement goodbye.

A brand new list of HCPCS codes — including docetaxel and bevacizumab updates — goes into effect Jan. 1 and our 8-step superbill maintenance plan will stop denials in their tracks for 2010.

Not using the proper codes will lead to claim rejection, which means “not receiving the proper reimbursement. And no one wants to start out their new year that way,” points out Lisa Martin, CPC, CIMC, CPC-I, who oversees the charge operations for a large, independent community cancer center in central Illinois and is an active instructor for the AAPC’s Professional Medical Coding Curriculum.

1. Docetaxel Do: Swap J9170 for J9171

The most widely used of the new chemotherapy HCPCS codes may prove to be J9171 (Injection, docetaxel, 1 mg), says Martin. Oncologists may prescribe docetaxel (Taxotere) for breast cancer, non-small cell lung cancer, prostate cancer, gastric cancer, and head and neck cancers.

Units alert: HCPCS 2010 deletes 2009 docetaxel code J9170 (Injection, docetaxel, 20 mg). The main difference is how you’ll calculate units. In 2009, you reported 1 unit for every 20 mg. In 2010, you’ll report 1 unit per 1 mg. If you fall into old habits, billing 1 unit for every 20 mg, you’ll only get 5 percent of the reimbursement you’re due, warns Roberta Buell, MBA, in her Nov. 17 E-Reimbursement newsletter for OnPoint Oncology in Sausalito, Calif.

2. Focus on J9155 for Firmagon

Depending on your specialty, you may find J9155 (Injection, degarelix, 1 mg) useful in the new year, says Martin.Oncologists prescribe degarelix (Firmagon) for patients with advanced prostate  cancer.

As with the new docetaxel code, you’ll report 1 unit for every 1 mg of degarelix.

3. Choose J9328 for IV Temozolomide

New code J9328 (Injection, temozolomide, 1 mg) may be of more interest to certain practices, says Martin.

Temozolomide (Temodar) treats particular types of brain cancer, specifically glioblastoma multiforme (coded as a malignant neoplasm based on site) and refractory anaplastic astrocytoma (also coded as malignant neoplasm by site). Remember that J9328 is particular to the intravenous formulation, not the oral drug.

4. Say ‘So Long’ to Short Lived Q2024

Confusion abounded when CMS created Q2024 (Injection, bevacizumab, 0.25 mg), effective Oct. 1, 2009. Oncology coders already had J9035 (Injection, bevacizumab, 10 mg) for bevacizumab (Avastin).

The lower dosage amount (0.25 mg per unit) made Q2024 more appropriate for ophthalmologists who use smaller amounts. But their outcry about payment problems encouraged CMS to delete Q2024, bringing much cheering from oncology and ophthalmology coders alike.

Bottom line: In 2010, continue to use old faithful code J9035 for bevacizumab

5. Move Mozobil Coding to J2562

If you provide plerixafor (Mozobil) injections, be sure you highlight new code J2562 (Injection, plerixafor, 1mg). The FDA approved the drug in 2008 for patients with non- Hodgkin lymphoma and multiple myeloma. When combined with granulocyte-colony stimulating factor (GCSF), plerixafor stimulates stem cells to move out of the bone marrow and into the blood stream so the physician may collect the cells for later autologous transplant.

(“Autologous” means the cells are transplanted back into the same patient.)

Tip: The codes you may use for G-CSF include filgrastim (Neupogen) codes J1440 (Injection, filgrastim [G-CSF], 300 mcg) and J1441 (Injection, filgrastim [GCSF], 480 mcg). Ensure, however, that you choose the most appropriate code based on the strength ordered and administered according to the supporting documentation.

6. Add J2796 for ITP Patients

Practices treating patients for chronic immune (idiopathic) thrombocytopenic purpura (ITP) need to know about J2796 (Injection, romiplostim, 10 micrograms). Romiplostim (Nplate) stimulates bone marrow megakarocytes to produce platelets, helping ITP patients, who have lower than normal platelet counts.

7. Jump to J7185 for Xyntha in 2010

Xyntha antihemophilic factor will get an upgrade from temporary code Q2023 (Injection, factor VIII [antihemophilic factor, recombinant] [Xyntha], per I.U.) to new permanent code J7185, which has the same descriptor.

Because of this change, HCPCS 2010 deletes Q2023 and tweaks the descriptor for J7192, making it a “not otherwise specified” code:

• 2009: J7192 — Factor VIII (antihemophilic factor, recombinant) per IU

• 2010: J7192 — Factor VIII (antihemophilic factor, recombinant) per IU, not otherwise specified.

8. Separate Ferumoxytol Codes by ESRD Use

The iron containing product ferumoxytol (Feraheme) has two new temporary codes for 2010:

• Q0138 — Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-ESRD use)

• Q0139 — Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for ESRD on dialysis).

Note that Q0138 is specific to non-end stage renal disease (non-ESRD) use and Q0139 is for ESRD patients on dialysis.

Currently, the drug has FDA approval for patients with chronic kidney disease. Interestingly, the drug also has potential as an MRI contrast agent and may prove useful in tumor imaging.

Remember: You can download the latest HCPCS file from the CMS Web site here.

AUDIO ON-DEMAND: 2010 Oncology Coding Update.

Oncology Coding Reference CD Collection for 2010.

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