Oncology & Hematology Coding Alert

CMS won't be using J9001 for Doxil once the change takes place in July.

One of the side effects of drug shortages is that coders have to determine which codes to use for replacement drugs. When deciding how to report two substitution drugs properly -- Lipodox and Fusilev -- consider these recent updates from CMS and Noridian Medicare.

Prepare to Use Q2049 This Summer

A shortage of Doxil has led to the temporary importation of a replacement drug, Lipodox. Both Doxil and Lipodox involve a doxorubicin hydrochloride liposome injection.

CMS has announced new HCPCS codes for Lipodox and Doxil. The codes will become effective July 1, 2012, says Kelly Loya, CPC-I, CHC, CPhT, manager for Sinaiko Healthcare Consulting Inc., a reimbursement services division of Altegra Health.

As you can see from the new codes' definitions, they distinguish between Doxil and Lipodox:

• Q2048, Injection, doxorubicin hydrochloride, liposomal, Doxil, 10 mg
• Q2049, Injection, doxorubicin hydrochloride, liposomal, imported Lipodox, 10 mg.

To make way for these new codes, the July HCPCS update indicates it will revise Doxil's current code J9001 (Injection, doxorubicin hydrochloride, all lipid formulations, 10 mg) and change its coverage status to "I." That status means the code is not payable by Medicare (as of July 1).

Codes Q2048 and Q2049 both show coverage status "C," indicating coverage is at the carrier's discretion. (You'll find the HCPCS update at www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS_Quarterly_Update.html in the file titled "Other Codes effective July 1, 2012.")

Before the announcement of the new codes, at least one payer, Noridian Medicare, had instructed its providers to report J9001 for imported Lipodox.

In the payer's words: "Doxil® (J9001) may be substituted with Lipodox® (J9001) which temporarily should be coded as J9001 -- until further notice," according to the March 20, 2012, announcement.

Uses: Physicians may order liposomal doxorubicin HCL to treat ovarian cancer when platinum-based chemotherapy has failed or to treat AIDS-related Kaposi's sarcoma when chemotherapy has failed. An additional indication is combination with bortezomib (Velcade) to treat multiple myeloma when the patient has received prior therapy other than bortezomib.

Swap J0640 for J0641 for Leucovorin Replacement

Another drug shortage oncology coders have had to face involves leucovorin. The codes and agents involved are as follows:

• Leucovorin: J0640, Injection, leucovorin calcium, per 50 mg
• Levoleucovorin (Fusilev): J0641, Injection, levoleucovorin calcium, 0.5 mg.

Noridian addressed this issue in the same March 20 announcement that discussed Lipodox. The contractor instructed its providers that "Leucovorin (J0640) may be substituted with levoleucovorin (J0641) until such time as the shortage is resolved."

Uses: Before you report either leucovorin or levoleucovorin, be sure documentation supports medical necessity. "Leucovorin is only necessary in limited circumstances where folinic acid is needed and the patient cannot use regular folate/folic acid," Noridian states. The physician may order it to counteract certain effects of methotrexate or enhance certain effects of 5-fluorouracil.

Resources: To find the Noridian announcement, posted March 20, 2012, head to www.noridianmedicare.com/partb/. In the Quick Search box at the top of the page enter "leucovorin doxil," and click Go. When the results page appears, click the link for "Leucovorin and Doxil Shortages." You can find more information on drug shortages at www.fda.gov/Drugs/DrugSafety/DrugShortages/default.htm.

Be sure to verify coding and coverage information with the relevant payer. For instance, Trailblazer's Local Coverage Determination (LCD) 2963 also indicates coverage of J0641 for levoleucovorin (www.trailblazerhealth.com/Tools/LCDs.aspx?ID=2963&DomainID=1) for specific indications.