Antineoplastic – MedicalCodingNews.Org

Learn the Best Ways to Navigate Codes For Cisplatin, Cyclophosphamide, and Vincristine

The recently released HCPCS 2011 code-set reveals a slew of deletions, streamlining your drug coding choices. Cisplatin, cyclophosphamide, and vincristine are among the affected drugs.

This change should simplify billing, particularly if the system your practice or facility uses, such as Pyxis or Lynx, limits you to a single code and billable unit for a drug, says Lisa S. Martin, CPC, CIMC, CPC-I, chargemaster specialist for OSF Healthcare System in Peoria, Ill. “As a consultant, I saw different facilities using only the 100 mg code [for example] for that very reason, so this change should facilitate more consistent and compliant billing practices.”

While these changes have a positive side, “there are always considerations that will arise,” Martin says. For example, if your practice uses different vial sizes, you will need to be alert for the different and specific national drug code (NDC) numbers for the agent dispensed to the patient when you send a claim to a payer who requires NDC information, she warns.

Cisplatin, ordered particularly for patients with metastatic testicular or ovarian neoplasms, or advanced bladder cancers, is one of the many agents affected by the HCPCS 2011 shake-up.

HCPCS 2011 makes a small wording revision to J9060, notes Roberta Buell, MBA, of onPoint Oncology in her Nov. 9 e-Reimbursement newsletter:

2010: J9060 – Injection, cisplatin, powder or solution, per 10 mg
2011: J9060 – Injection, cisplatin, powder or solution, 10 mg.

Delete code J9062 (Cisplatin, 50 mg). It will no longer be available for use in 2011. You should use J9060 to report cisplatin, brand name Platinol, when supplied for 2011 dates of service.

Cyclophosphamide is an alkalyting agent that works as an antineoplastic and immunosuppressant. You may see it called Cytoxan or Neosar.

At 1 unit per 100 mg, J9070 (Cyclophosphamide, 100 mg)...

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January 3, 2011

Coding Challenge / modifier 53

Oncology Coding: Determine the Proper Adverse Reaction Code

Remember to describe all the circumstances surrounding a push to get full reimbursement.

Question: If a non-Hodgkin’s lymphoma patient has an adverse reaction to Rituximab less than 15 minutes into the ordered hour-long infusion, should I report a push?

Answer: Experts suggest the most appropriate way to report a discontinued infusion is to append modifier 53 (Discontinued procedure) to the appropriate chemotherapy infusion code, such as 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug).

You should use modifier 53 when a physician stops a procedure “due to extenuating circumstances or those that threaten the well-being of the patient,” according to CPT.

Modifier 53 describes an unexpected problem, beyond the physician’s or patient’s control, that necessitates ending the procedure. The physician doesn’t elect to discontinue the procedure as much as he is forced to do so because of the circumstances.

Push: CPT guidelines include “an infusion of 15 minutes or less” as one definition of a push, but 96413-53 describes the ordered and provided service more accurately than a push code (such as 96409, Chemotherapy administration; intravenous, push technique, single or initial substance/drug).

HCPCS: Your documentation should describe the circumstances, the administration start and stop times, and the amount of drug delivered and discarded. If you’re coding for the drug (J9310, Injection, rituximab, 100 mg), you should be able to report the entire amount, assuming you discarded the amount not administered.

ICD-9: Remember also to report the appropriate ICD- 9 codes, such as V58.12 (Encounter for antineoplastic immunotherapy) and 202.8x (Other lymphomas), and a code to indicate why the procedure stopped, such as V64.1 (Surgical or other procedure not carried out because of contraindication) or E933.1 (Drugs, medicinal, and biological substances causing adverse effects in therapeutic use; antineoplastic and immunosuppressive drugs).

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June 3, 2010