HCPCS Update: J1561's New Look Discloses Trade Name and Admin Modifications

Plus: Check out more new HCPCS codes for pain and fracture prevention.

Modifications to acetaminophen, denosumab, and immune globulin coding are sure to keep you on your toes in 2012. Keep a close eye on the administration methods for Ofirmev and Gamunex-C, in particular. Read this expert medical coding article and know more about what HCPCS codes apply.

J0131: Add a New Acetaminophen Code

In 2012, there is an addition of a HCPCS code for acetaminophen administered by infusion: J0131 (Injection, acetaminophen, 10 mg). The brand name for this particluar injectable form is Ofirmev.

Physicians might order the drug for the management of mild to moderate pain; management of moderate to severe pain along with adjunctive opoid analgesics; and also for fever reduction in adults and children 2 years or older.

2012 example: Staff administers 1000 mg of Ofirmev over 15 minutes. You should report J0131 x 100 units (1000 mg administered divided by the 10 mg in the definition). For the administration, report 96374 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; intravenous push, single or initial substance/drug).

J0897: Prolia and Xgeva Get a Specific Code

As of Jan. 1, 2012, you'll be able to report denosumab with ease using new HCPCS code J0897 (Injection, denosumab, 1 mg). This antibody works by decreasing bone resorption and increasing bone density. Brand names for denosumab consist of Prolia and Xgeva.

Prolia is specified to increase bone mass in individuals at high fracture risk because of certain cancer therapies, especially in men getting androgen deprivation therapy to treat nonmetastatic prostate cancer as well as in women with breast cancer who receive adjuvant aromatase inhibitor therapy. According to the HCPCS agenda, Xgeva is intended for prevention of skeletal-related events (SREs) in patients with bone metastases from solid tumors. In 2011, denosumab didn't have a definite HCPCS code for practices to report, so they used J3590 (Unclassified biologics) on Medicare claims.

2012 example: Staff administers a 120 mg subcutaneous injection of Xgeva. You must report 120 units of J0897 for the supply and 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the injection.

J1557 and J1561: Watch IG Brand Names

Don't overslook two changes to immune globulin (IG) used to treat immunodeficiencies. Out of these HCPCS codes, one is a new code and one is a revision of an existing code.

New: Intravenous IG (IVIG) product Gammaplex gets its own individual code for 2012: J1557 (Injection, immune globulin, [Gammaplex], intravenous, non-lyophilized [e.g. liquid], 500 mg).

In 2011, your best option for Gammaplex was J1599 (Injection, immune globulin, intravenous, non-lyophilized [e.g. liquid], not otherwise specified, 500 mg). As per HCPCS agenda, the new HCPCS code ( source "http://www.supercoder.com/hcpcs-codes/") was requested as Gammaplex is different from other licensed IVIG products in numerous significant respects that can influence product tolerability and safety.

2012 example: Staff administers a 2-hour, 16,350 mg Gammaplex infusion. You must report 33 units of J1557. (Divide the 16,350 mg administered by the 500 mg in the definition to get 32.7. Round up to 33.) You must report 96365 for the first hour of administration. As far as the second hour is concerned, report +96366 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; each additional hour [List separately in addition to code for primary procedure]).