Which CPT And HCPCS Codes for MOPP?

While coding for your oncology practice, you may sometimes question – which CPT and HCPCS codes are appropriate for MOPP? Answer: Well, the MOPP (also called MVPP) combination chemotherapy regimen includes:

M: Mechlorethamine (Mustargen)
O: Vincristine (Oncovin or Vincasar)
P: Procarbazine (Matulane)
P: Prednisone.

You should code mechlorathemine using J9230 (Injection, mechlorethamine hydrochloride,
[nitrogen mustard], 10 mg). Since it's an antineoplastic, you should report administration using the appropriate chemotherapy administration code(s) (96401-96549).

You should report vincristine using J9370 (Vincristine sulfate, 1 mg). Bear in mind that HCPCS 2011 deleted J9375 (Vincristine sulfate, 2 mg) and J9380 (Vincristine sulfate, 5 mg). Since vincristine also happens to be a chemotherapy drug, you should again use the proper chemotherapy administration code(s) (96401-96549). Do not report these drugs: As part of the MOPP regimen, Procarbazine and prednisone are given orally. HCPCS offers S0182 (Procarbazine hydrochloride, oral, 50 mg) and J7506 (Prednisone, oral, per 5mg), however you shouldn't report supply (HCPCS) or administration (CPT) codes for these drugs on your Part B claims. CMS doesn't cover ‘self-administered' drugs under Part B. (Take a look at Medicare Benefit Policy Manual, chapter 15, section 50.5, www.cms.gov/Manuals/IOM/list.asp.) Exception: The provider may consider it necessary to administer the injectable form of prednisone, such as J1030 (Injection, methylprednisolone acetate, 40 mg). In that rare instance, you may be able to code the drug and administration.

Medicare benefit Policy Manual, chapter 15, section 50.4.3, explains that Medicare does not cover a medication's injectable form if the oral route is standard and medically proper. However the manual indicates there could be an exception if special medical circumstances justify an injection rather than the oral form. If the injectable form is utilized, the provider should briefly document the reason why to help support your code choice.

Note of caution: See to it that you code based on the detailed documentation rather than from a protocol's abbreviation. For instance, the oncologist may change the order based on white blood and platelet counts. For more on this and for other medical coding updates pertaining to CPT and HCPCS codes, sign up for a one-stop medical coding guide like Supercoder.com