Hit these resources on Medicare's oral anti-emetic policy.
In case your practice reports oral anti-emetics, ensure you're up on the latest ondansetron medical coding news or you could start facing denials.
This drug gota new HCPCS code, effective Jan. 1, 2012: Q0162 (Ondansetron 1 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen).
To make room for this novel code, HCPCS deleted Q0179 (Ondansetron hydrochloride 8 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen).
Bottom line: Reporting Q0179 for a 2012 date will bring an instantaneous denial. You must use HCPCS code Q0162 instead.
Zuplenz Factors Into Unit Change
Pay attention to how the HCPCS code change influences unit reporting. For 2011's Q0179, one unit represented 8 mg. In 2012, one unit of Q0162 represents only 1 mg.
The change permits for more precise reporting of the ondansetron oral soluble films sold as Zuplenz. The films are obtainable in 4 mg and 8 mg doses. Even though HCPCS codes specific to the oral films were requested, the novel code was created so that it could be allocated to any oral dose form available.
Brush Up on Oral Anti-Emetic Rules
Prior to reporting HCPCS code Q0162, take heed. There is a precise set of guidelines for oral anti-emetics to be considered payable by Medicare.
Smart idea: You must review Medicare's national resources on reporting oral anti-emetics.
Claims processing jurisdiction is one vital area covered in the MCPM. Practices must bill the oral anti-emetic to their Durable Medical Equipment Medicare Administrative Contractor (DME MAC). In contrast, you'd report an intravenous anti-emetic to your local carrier (Part B MAC).
Read on: For Medicare patients, you also must check for local coverage determinations (LCDs) that address coverage for oral anti-emetics by the suitable region's DME MAC.
The LCD may disclose specific modifiers you must use with the HCPCS code. For instance, modifier KX (Requirements specified in the medical policy have been met) may apply.
Moreover, to support oral anti-emetic coverage, the patient should be receiving what is considered to be a highly emetic chemotherapy agent, for instance Cisplatin or other drugs listed on the DME MAC's LCD," says Martin. (The MCPM provides a list of the chemotherapy agents that support necessity for the oral anti-emetic tri-pack of aprepitant [Emend], a 5-HT3 antagonist [such as ondansetron], and dexamethasone.)
Remember: Commercial insurances also may have entirely different payment policies for oral medications. Confirm the payer policy to see how or even if these would be paid under the patient's medical benefits.
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In case your practice reports oral anti-emetics, ensure you're up on the latest ondansetron medical coding news or you could start facing denials.
This drug gota new HCPCS code, effective Jan. 1, 2012: Q0162 (Ondansetron 1 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen).
To make room for this novel code, HCPCS deleted Q0179 (Ondansetron hydrochloride 8 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen).
Bottom line: Reporting Q0179 for a 2012 date will bring an instantaneous denial. You must use HCPCS code Q0162 instead.
Zuplenz Factors Into Unit Change
Pay attention to how the HCPCS code change influences unit reporting. For 2011's Q0179, one unit represented 8 mg. In 2012, one unit of Q0162 represents only 1 mg.
The change permits for more precise reporting of the ondansetron oral soluble films sold as Zuplenz. The films are obtainable in 4 mg and 8 mg doses. Even though HCPCS codes specific to the oral films were requested, the novel code was created so that it could be allocated to any oral dose form available.
Brush Up on Oral Anti-Emetic Rules
Prior to reporting HCPCS code Q0162, take heed. There is a precise set of guidelines for oral anti-emetics to be considered payable by Medicare.
Smart idea: You must review Medicare's national resources on reporting oral anti-emetics.
Claims processing jurisdiction is one vital area covered in the MCPM. Practices must bill the oral anti-emetic to their Durable Medical Equipment Medicare Administrative Contractor (DME MAC). In contrast, you'd report an intravenous anti-emetic to your local carrier (Part B MAC).
Read on: For Medicare patients, you also must check for local coverage determinations (LCDs) that address coverage for oral anti-emetics by the suitable region's DME MAC.
The LCD may disclose specific modifiers you must use with the HCPCS code. For instance, modifier KX (Requirements specified in the medical policy have been met) may apply.
Moreover, to support oral anti-emetic coverage, the patient should be receiving what is considered to be a highly emetic chemotherapy agent, for instance Cisplatin or other drugs listed on the DME MAC's LCD," says Martin. (The MCPM provides a list of the chemotherapy agents that support necessity for the oral anti-emetic tri-pack of aprepitant [Emend], a 5-HT3 antagonist [such as ondansetron], and dexamethasone.)
Remember: Commercial insurances also may have entirely different payment policies for oral medications. Confirm the payer policy to see how or even if these would be paid under the patient's medical benefits.
Sorce URL :-
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