Oncology & Hematology Coding Alert

Missing these new HGB and HCT coding policies could sink your claims When your practice submits your next ESA claim to Medicare, you could be putting reimbursement at risk if you haven't combed through Medicare's latest reporting policy. Good news: We-ve done the work for you and analyzed what you need to know. The lowdown: Beginning Jan. 1, 2008, if any of your patients are receiving services involving Part B anti-anemia drugs -- other than erythropoiesis stimulating agents (ESAs) used in cancer treatment that are not self-administered -- or ESA administrations, you-ll need to report their most recent hemoglobin (HGB) or hematocrit (HCT) levels, according to CR5699. What this means to you: Before you submit a claim, be sure your clinical staff has documented these levels in the patient's chart so you can include it on the claim. But that's not all. Follow these tips to keep your claims on the up and up. 1. The Implementation vs. Effective Debate Continues "The national coverage determination is very hard to interpret -- one minute you think you have the policy down pat, and the next minute you-ll be scratching your head. There are issues because the NCD is not straightforward, and there are too many loopholes in the policy without clear explanation," says Kelly Reibman, CPC, a biller with oncologist Mariette Austin, PhD, MD, in Bethlehem, Pa. One potential issue that could cause some confusion for coders is the difference between CR5699's Jan. 1 effective date and the implementation date (April 7), Reibman says. Effective date means the date the guideline/coding change becomes effective, and implementation date means the date it will be applied, such as by carriers, says Catherine Brink, CMM, CPC, CMSCS, president of Healthcare Resource Management in Spring Lake, N.J. Potential problem: If the dates indicate that all claims for services on or after Jan. 1, 2008, have to meet all requirements but that contractors won't be required to process these services until April 7, 2008, this could create a three-month lag in reimbursement. 2. Know the Injection Codes to Keep Claims Clean In addition to watching HGB and HCT levels, there are several HCPCS codes you-ll need to keep in mind for reporting ESA injections: - J0881 -- Injection, darbepoetin alfa, 1 mcg (non- ESRD use) - J0882 -- Injection, darbepoetin alfa, 1 mcg (for ESRD on dialysis) - J0885 -- Injection, epoetin alfa (for non-ESRD use), 1000 units - J0886 -- Injection, epoetin alfa, 1000 units (for ESRD on dialysis) - Q4081 -- Injection, epoetin alfa, 100 units (for ESRD on dialysis). Although you should be familiar with all the codes from this list, the codes you-ll need to focus on primarily for oncology and hematology [...]