HCPCS Codes 2012: Novel HCPCS Code Will Get You $32,000 x 3 – Only If You Bill It Appropriately

HCPCS Codes 2012: Novel HCPCS Code Will Get You $32,000 x 3 – Only If You Bill It Appropriately

In case your urologist carries out a novel treatment carried out for asymptomatic or minimally symptomatic metastatic castrate resistant carcinoma of the prostate by means of the drug Provenge or drug Sipuleucel-T, pay attention to new HCPCS codes 2012.
HCPCS Codes 2012, Medical Coding, Hcpcs Codes

Include correct primary and secondary diagnosis codes to guarantee payment.

In case your urologist carries out a novel treatment carried out for asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) carcinoma of the prostate by means of the drug Provenge or drug Sipuleucel-T, pay attention to new HCPCS codes 2012. Read this article to safeguard your payment and accurate medical coding.

Get to Know the Procedure

Medicare permits a patient one treatment with Provenge in their lifespan, which involves three distinct infusions within a two week period,

Blood is taken from the patient and then it is exposed to prostate cancer cells, preparing the patient's white blood cells to attack the cancer cells when reinfused into the patient. This also stimulates a recruitment of added white blood cells to put an end to the tumor. Provenge is the first in a new class of therapy that is intended to activate a patient's individual antigen-presenting cells to stimulate an immune response against prostate cancer.

Report the New Code 3 Times For Full Treatment

From the HCPCS codes 2012, the code for this particular procedure is Q2043 (Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion). This code signifies the anti-neoplastic treatment for this specific type of tumor.

You must keep in mind that the code descriptor states "per infusion," implying that in case the patient gets three infusions throughout the two-week treatment period, you must report HCPCS code Q2043 three distinct times. You bill this once for every single infusion, and Medicare will reimburse you $32,000 per infusion. The purchased price for the drug is approximately $30,189 per treatment. Medicare will reimburse this cost and above a six percent increase/profit.

Don't miss: While you report Q2043, from the HCPCS codes 2012, for this particular cancer treatment, keep in mind that this HCPCS code covers all additional preparatory procedures, for instance the collection of cells from the patient, the preparation as well as transportation of the cells to a specialized lab, and then the infusion itself.

Support Claim With Appropriate Diagnostic Codes

While reporting HCPCS code Q2043, the diagnosis codes should include 185 (Malignant neoplasm of prostate) as the primary diagnosis and no less than one metastatic diagnostic code as the secondary diagnosis, Potential secondary diagnostic codes involve the following:

196.1 – (Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes)

196.2 – ( intra-abdominal lymph nodes)

196.5 – ( lymph nodes of inguinal region and lower limb)

196.6 – ( intrapelvic lymph nodes)

196.8 – ( lymph nodes of multiple sites)

197.0 – ( Secondary malignant neoplasm of lung)

198.1 – ( other urinary organs)

198.5 – ( bone and bone marrow)

198.7 – ( adrenal gland)

198.82 –( genital organs.)