Ondansetron Update: Q0162 Replaces Q0179 in 2012

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.

Sorce URL :-

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]).

Hyaluronic Acid Injections: 'Count Correctly' to get your Rightful Reimbursements

For some time, Hyaluronate injections have had its own J code. However it has been changed from 'unspecified' to its own assigned code, back to 'unspecified' and then back to an assigned HCPCS code. Now that all hyaluronate injections fall under the same code, here are three medical coding tips to remember and help you calculate the right way.

Validate the type of medication

Physicians make use of hyaluronate injections to lessen the patient's pain owing to osteoarthritis of the knee. The medications achieve the same purpose and you report both types of injections with J7325. Correct coding depends on the medication used and the number of units you report. Synvisc-One is a one-shot injection equaling 6 cc of the medication. The patient sees your physician once for the full injection, which you report as 48 units of J7325 (2 cc = 16 g, so 6 cc = 48 mg). Physicians administer the other forms of hyaluronate as a series of injections instead of one shot at a single patient visit. Watch the dosage amounts closely so that you will report the correct number of J7325 units for each administration.

Chart note: Owing to the difference in calculations and unit reporting, the doctor must clearly document the medication used and number of units administered. Medication reimbursement can be low; as such wrong or unclear documentation could mean the difference between some payment versus virtually none. Some providers give patients a prescription for hyaluronate (depending on the insurer) and ask them to get the medication and return to the physician's office for the injection.

Injection: Code J7325 represents the medication only; as such you still need to report the injection procedure. Submit 20610; take a look at the diagnosis code. Medicare will only pay for hyaluronate injections to treat osteoarthritis of the knee. You have several diagnosis choices; as such be sure one of these applies to help smooth your claims processing: 715.16, 715.26, 715.36, and 715.96.

Anatomy note: Your 'additional digit' choices for the 715. xx code family do not include a specific option for knee. While selecting the best anatomic choice, take the knee part of the lower leg in place of pelvic region and thigh.

Figure out whether evaluation & management and modifiers apply

Some visits for hyaluronate injections qualify for an evaluation & management code or modifiers; however others do not. If the patient comes to your office specifically for a scheduled Synvisc-One injection, you will only report the injection code. However, if the physician completes another service during the visit, an E/M code might apply.

For more on this and for other medical coding articles to assist your orthopedic coding, sign up for a one-stop medical coding guide like Supercoder.

Tips To Get Proper Payments for Your Hemoccult Test Coding

How should you tackle this scenario: A 60-year old patient presented in the office complaining of diarrhea preceded by intestinal cramping. This lasted for two weeks. The patient has no history of cancer in the family. He also did not feel nauseous at all. To test for both parasites and blood, the doctor took a stool sample.

Well, you should assign two codes that you can use for post digital rectal exam (DREs) and consecutive specimen collection: Since 2007, CPT has assigned two codes that you can use for post digital rectal exam (DREs) and consecutive specimen collection: 82270 and 82272.

From January 1, 2007, CPT has terminated HCPCS code G0107 and replaced by 82270 even for routine Medicare screening FOBT.

In this scenario, it is not clear whether the doctor examined the samples herself or sent them to the lab. But then, as a general practice, parasite exams almost always take place in the lab. In this instance, the lab would be paid for the test directly.

You should ask the reason for the test. 'Why' is the keyword that can lead you to the proper CPT for FOBT; therefore do not hesitate to find out why your gastroenterologist has ordered it. If the test is for screening purposes, then you should report 82270. The ICD-9 code for screening hemoccults should be V76.51.

Do not forget: There are interval limitations for screening established by Medicare and most commercial carriers. On the contrary, if a patient presents to the office with symptoms, the gastroenterologist would carry out a diagnostic FOBT, and you should bill it with 82272. CPT 82272 can be billed if 1 to 3 specimens are obtained. The diagnosis code for the test would be related to the patient's presenting symptoms.

If you want to keep the money flowing for in-office examination of fecal occult blood test (FOBT), sign up for a one-stop medical coding guide like Supercoder.

Four Phases to Help you Begin Your ICD-10 Preparations Right Way

Start your initial plan of conversion straight away so you can project your practice's timeline.

Medical practices that have got an early start to ICD-10 transition say that it's not an easy task as far as the process's vast nature is concerned. So if your practice has been putting off its preparations, it is time to get onboard the ICD-10 train.

Procrastinators should be careful: ICD-10 will go into effect on October 1, 2013, and CMS will not provide you a grace period post that date. To put it in other words, you will be better placed of you have your ICD-10 systems ready prior to that date so that your claims continue to flow smoothly. Experts warn that if you're not ready, your claims may not flow at all.

Key: The transition will have no effect on CPT code or HCPCS code use. Both of these coding systems will remain to be used as they are now.

4 phases help you begin preparing right away

At a medical practice, every month is a busy month. But then it's very important that you make time for your ICD-10 preparation sooner rather than later. An important takeaway message from today's session is the totally critical importance of not delaying in getting this implementation process started.

You should institute a well-planned implementation process to be ready in year 2013 rather than hastily scrambling your ICD-10(http://www.supercoder.com/icd-10/icd-10-bridge) program together at the last minute.

Here's how you should do it: break your ICD-10 implementation planning program into four phases. Here're the goals for each phase with suggested timelines:

Phase 1: Implementation plan development and impact assessment, suggested to span from the first quarter of year 2009 through the second quarter of this year

Phase 2: Implementation preparation, suggested to take place between the first quarter of this year and the second quarter of 2013

Phase 3: "Go live" preparation, should potentially take place between the 1st and 2nd quarters of 2013

Phase 4: Post-implementation follow-up, suggested to occur between the fourth quarter of 2013 and fourth quarter of 2014.

Normally, your phase one work should be approaching completion or at least be well on its way. For those of you who may not have gotten started yet or who have hardly gotten started, I urge you to move forward with this as soon as possible.

Reason: You will not be able to schedule phases through four until phase one is done, and you need to be able to calculate the resources you will require for those subsequent phases. Till you know the scope of the effect of ICD-10 in your organization, you do not know how much time and resources will be required to finish the preparation activities; as such you do not want to wait too long prior to making that assessment.

G0105 Is Matchless For No-Finding Service

My gastroenterologist carried out a colonoscopy on a patient with a V16.0 diagnosis. The patient is 50 years old and does not have coverage for screening colonoscopy because of his age. However his insurance considers V16.0 a medical diagnosis and could have paid for the service. The colonoscopy showed no findings. As such, why did the insurance deny my claim when I billed V16.0 with 45378?

Well, you should have determined the advantages of the procedure and verified the payment prior to performing it on the patient. Colonoscopy procedures in patients minus active symptoms don't qualify as an emergency and the best way to ensure that the physician is paid for the service is to get phone verification of benefits. What's more, regulation does not require insurance coverage for high-risk screening colonoscopy.

Even though some insurance would accept G0105 Colorectal cancer screening; colonoscopy on individual at high risk) in place of 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) to qualify for screening benefits, you should not bill it unless the insurance company representative instructed it during the verification process. Commercial carriers for non-Medicare patients normally do not recognize G0105, which is a CMS code.

Intent: G0105 is a CMS HCPCS code that applies for screening of a patient that has a high-risk for colorectal neoplasia. Examples would be universal ulcerative colitis (556.6) or a history of malignant neoplasm of the lower gastrointestinal tract (V10.0). When the service reveals no findings, you should report this HCPCS code(Source "").

No modifier would be proper to use on 45378 if you insist on using this code. Nevertheless, you could try sending all notes with your claim. If the patient was referred for the procedure, you might want to ask the referring physician if she would write a letter validating medical necessity.

HCPCS 2011 Brings new Options for Lymph Cancer Drugs

HCPCS 2011: C codes are appropriate only for Hospital Outpatient Prospective Payment System claims.

When all other treatments have failed, take a look at these drugs

You'll have three new J codes for leukemia and lymphoma treatments available for use in January, 2011.

J9302 answers call for Arzerra Code

If you provide Arzerra injections, you should take note of new code J9302 (Injection, ofatumumab, 10 mg). Oncologists normally use the medication to treat chronic lymphocytic leukemia in adults who haven't responded well to fludarabine or alemtuzumab.

As the suffix -mab in ofatumumab points to, this medication is a monoclonal antibody.

Remember: Earlier, hospitals had a C code available for this agent, C9260 (Injection, ofatumumab, 10 mg). However this code makes an exit in the latest HCPCS code sets. (Note that C codes are appropriate only for Hospital Outpatient Prospective Payment System claims.)

Train eyes on J9307 for Folotyn

One more new J code for 2011 is J9307 (Injection, pralatrexate, 1 mg), which is just right for Folotyn.

Oncologists normally use this folate analogue metabolic inhibitor to kill cancer cells in patients with peripher al T-cell lymphoma that hasn't responded to other medications or has returned.

HCPCS 2011 also axes the C code available to hospitals for this drug, C9259 (Injection, pralatrexate, 1 mg).

Flip to J9315 for Romidepsin

If your documentation shows your practice supplied Istodax, you have J9315 (Injection, romidepsin, 1 mg) at your service in the new year. The drug is a histone deacetylase inhibitor that slows the growth of cancer cells. It is intended for use in patients with cutaneous T-cell lymphoma who have been treated earlier with another drug.

In 2010, hospitals use C9265 (Injection, romidepsin, 1 mg) for this drug, however HCPCS 2011 deletes this code.

Supercoder give you ways to boost your Hemoccult Test Coding.

If you want to keep the money coming for in-office examination of fecal occult blood test (FOBT), you should train eyes on the difference between three hemoccult codes and their purpose.

Here's a scenario:

A 60-year old patient presented in the office complaining of diarrhea preceded by intestinal cramping, which lasted two weeks. The patient has no history of cancer in the family. He also did not feel nauseous at all. The physician took a stool sample to test for both parasites and blood. How should you approach this situation?

Assign the right code for each type of collection

Since the year 2007, CPT has assigned two codes that you can use for post digital rectal exam (DREs) and consecutive specimen collection:

82270

82272

Update: With effect from January 1, 2007, CPT has terminated HCPCS code G0107 and replaced by 82270 even for routine Medicare screening FOBT.

Remember: In the above scenario, it is not clear whether the doctor examined the samples herself or sent them to the lab. But as a general rule, parasite exams almost always take place in the lab. Here, the lab would be paid for the test directly.

Do not forget: There are interval limitations for screenings established by Medicare and most commercial carriers.

On the other hand, if a patient presents to the office with symptoms, the gastroenterologist would carry out a diagnostic FOBT, and you should bill it with 82272. One can bill CPT 82272 if 1 to 3 specimens are obtained. The diagnosis code for the test would be related to the patient's presenting symptoms.

Count number of tests

If you are still not sure whether you have got the right code by differentiating screening from diagnostic, you can look further into the test's details. Identify how many tests the gastroenterologist or lab performs. For a three-specimen collection, you would go for 82270. Use a single-specimen collection with 82272.

Red flag: Even though 82270 involves analysis of three specimens, you should always assign 82270 with a “1" in the units field. Some coders incorrectly interpret 82270's descriptor of “one to three simultaneous determinations" to mean they should bill “each of the three determinations with one unit of CPT 82270 (82270 x 3)." The revised description more clearly reminds providers that the code identifies as many as three consecutive determinations.

What if: The patient fails to collect all three samples. You may still bill 82270. If this happens, the laboratory should carry out analysis of the one or two collected specimen, report the results accordingly and record one unit of 82270.

Determine who obtains the sample

Where the sample is collected and who performs it can also include you in to the right FOBT code. CPT Code 82270 will always be billed as a separate service when the developer has been placed on the cards after the three completed cards (or one completed triple card) have been returned to the office. In a nutshell, the doctor should not collect the specimen in the office.

Instead you should use 82272 when the doctor carries out a digital rectal exam in the office and obtains a sample at that time.