Medical Billing and Coding
Plus: Permitted Anzemet units take a dive. Here's the reason.
In case you're dealing with denials for consecutive therapeutic infusions or anti-nausea medications, don't overlook these two Medicare-related updates to ensure accurate medical billing and coding.
1. Determine How to Handle +96367 Claims
You're in good company in case you've been deliberating why you're facing denials for greater than three units of +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion of a new drug/ substance, up to 1 hour [List separately in addition to code for primary procedure]).
The reason is a medically unlikely edit (MUE) of 3 for the code, effective Jan. 1, 2012. An MUE is a frequency edit that is applicable to Medicare claims via the Correct Coding Initiative (CCI).
Good news: CCI edit will change the MUE for +96367, announced the Community Oncology Alliance (COA) on its website.
The increased MUE is good news; however the change won't take place until April 1. That implies that you should decide how to handle claims for more than 3 units of +96367 till the change is effective. The practices may go for either of the following medical billing and coding practice:
For further details on this and for other medical coding updates, sign up http://www.supercoder.com/
(1) Hold applicable claims until April 1 when payers will apply the augmented MUE (because the change is retroactive to Jan. 1, the new MUE will apply to dates of service going back to that time).
(2) Send in claims at this time, and overcome the MUE edit, which is checked against each line independently, by reporting +96367 x3 on one line and after that +96367-59 (Distinct procedural service) with up to an additional 3 units on a second line.
2. FDA Move Affects Anzemet Allowed Units
Medical Billing and Coding Update: CMS is decreasing the allowed units for intravenous and intramuscular Anzemet, long used to avoid nausea and vomiting in patients getting chemotherapy.
Reason: The Food and Drug Administration (FDA) took a closer look at Anzemet's ability to cause heart rhythm problems. Based on the results, the FDA decided to add a contraindication to Anzemet's prescribing information mentioning that the injection form of Anzemet (dolasetron mesylate) must no longer be used to check nausea and vomiting associated with cancer chemotherapy (CINV) in pediatric as well as adult patients.
Medical Billing and Coding Update : The change affects code J1260 (Injection, dolasetron mesylate, 10 mg). The number of allowed units was not involved in the announcement, and you won't find J codes published in CMS's MUE table.
Don't miss: The FDA main that physicians might still order an Anzemet injection for preventing and treating postoperative nausea as well as vomiting as lower doses used are less likely to influence the electrical activity of the heart and leads to abnormal heart rhythms.
In case you're dealing with denials for consecutive therapeutic infusions or anti-nausea medications, don't overlook these two Medicare-related updates to ensure accurate medical billing and coding.
1. Determine How to Handle +96367 Claims
You're in good company in case you've been deliberating why you're facing denials for greater than three units of +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion of a new drug/ substance, up to 1 hour [List separately in addition to code for primary procedure]).
The reason is a medically unlikely edit (MUE) of 3 for the code, effective Jan. 1, 2012. An MUE is a frequency edit that is applicable to Medicare claims via the Correct Coding Initiative (CCI).
Good news: CCI edit will change the MUE for +96367, announced the Community Oncology Alliance (COA) on its website.
The increased MUE is good news; however the change won't take place until April 1. That implies that you should decide how to handle claims for more than 3 units of +96367 till the change is effective. The practices may go for either of the following medical billing and coding practice:
For further details on this and for other medical coding updates, sign up http://www.supercoder.com/
(1) Hold applicable claims until April 1 when payers will apply the augmented MUE (because the change is retroactive to Jan. 1, the new MUE will apply to dates of service going back to that time).
(2) Send in claims at this time, and overcome the MUE edit, which is checked against each line independently, by reporting +96367 x3 on one line and after that +96367-59 (Distinct procedural service) with up to an additional 3 units on a second line.
2. FDA Move Affects Anzemet Allowed Units
Medical Billing and Coding Update: CMS is decreasing the allowed units for intravenous and intramuscular Anzemet, long used to avoid nausea and vomiting in patients getting chemotherapy.
Reason: The Food and Drug Administration (FDA) took a closer look at Anzemet's ability to cause heart rhythm problems. Based on the results, the FDA decided to add a contraindication to Anzemet's prescribing information mentioning that the injection form of Anzemet (dolasetron mesylate) must no longer be used to check nausea and vomiting associated with cancer chemotherapy (CINV) in pediatric as well as adult patients.
Medical Billing and Coding Update : The change affects code J1260 (Injection, dolasetron mesylate, 10 mg). The number of allowed units was not involved in the announcement, and you won't find J codes published in CMS's MUE table.
Don't miss: The FDA main that physicians might still order an Anzemet injection for preventing and treating postoperative nausea as well as vomiting as lower doses used are less likely to influence the electrical activity of the heart and leads to abnormal heart rhythms.
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