Oncology & Hematology Coding Alert

Make a note of new dose units, route of administration and timing of chemotherapy.

Your physician may rely on oral anti-emetics to control nausea and vomiting in patients receiving chemotherapy. Changes in 2014 may complicate your reporting if you do not pay attention to new and revised requirements. Besides the new changes, here are some tips on sound reporting for oral anti-emetic agents.

What is New for 2014?

There are code changes for oral anti-emetics in 2014. A new code Q0161 (Chlorpromazine hydrochloride, 5 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) has been added for chlorpromazine. 

The old codes, Q0171 for 10mg and Q0172 for 25 mg of chlorpromazine hydrochloride have been discontinued in 2014. In 2014, you only have option Q0161 for every 5 mg dose of oral chlorpromazine hydrochloride when administered for use as a complete therapeutic substitute for an IV anti-emetic therapy at the time of chemotherapy treatment, but administration/dosing is not to exceed a 48-hour dosage regimen, says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Director of reimbursement and advisory services, Altegra Health, Inc. 

Table 1 lists the new codes for oral anti-emetic drugs and those that have been discontinued.

Note: New codes for oral anti-emetics reflect changes in dosage units that you can report. Refer to table 1 for details. The physician must also indicate on the prescription the beneficiary is receiving the oral anti-emetic drug as full therapeutic replacement for an intravenous anti-emetic drug as part of a cancer chemotherapeutic regimen. This is clearly reflected in the code descriptors.  “The reporting doses for the codes included below have been cut in half, which will require you to report twice the units for the same dose using the discontinued HCPCS codes,” Loya says.

Editor’s note: Read more about anti-emesis reporting in the next issue of Oncology Coding Alert Vol16N6.