Oncology & Hematology Coding Alert

Plus: Check out more new codes for pain and fracture prevention.

Changes 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.

J0131: Add a New Acetaminophen Code

HCPCS 2012 adds a code for acetaminophen administered by infusion: J0131 (Injection, acetaminophen, 10 mg). The brand name for this injectable form is Ofirmev.

Physicians may order the drug "for the management of mild to moderate pain; management of moderate to severe pain with adjunctive opoid analgesics; and for fever reduction in adults and children 2 years or older," according to the May 17, 2011, HCPCS Public Meeting Agenda (www.cms.gov/MedHCPCSGenInfo/downloads/Tues_May17thDrug-Agenda.pdf).

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 code J0897 (Injection, denosumab, 1 mg). This antibody works by decreasing bone resorption and increasing bone density. Brand names for denosumab include Prolia and Xgeva.

Prolia is indicated to increase bone mass in individuals at high fracture risk due to certain cancer therapies, specifically in men receiving androgen deprivation therapy to treat nonmetastatic prostate cancer and also in women with breast cancer who receive adjuvant aromatase inhibitor therapy. Xgeva is intended for "prevention of skeletal-related events (SREs) in patients with bone metastases from solid tumors," the HCPCS agenda states. In 2011, denosumab didn't have a specific HCPCS code for practices to report, so they used J3590 (Unclassified biologics) on Medicare claims, according to the HCPCS agenda.

2012 example: Staff administers a 120 mg subcutaneous injection of Xgeva. You should 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.

Bonus tip: Watch your payers for reporting preferences. For instance, TrailBlazer wants its providers to indicate in the claim's comment section which drug (Prolia or Xgeva) was administered. Additionally, Prolia claims require a diagnosis of 733.01 (Senile osteoporosis), and Xgeva claims require a diagnosis of 198.5 (Secondary malignant neoplasm of bone and bone marrow) for coverage (www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=14722).

J1557 and J1561: Watch IG Brand Names

Don't miss two changes to immune globulin (IG) used to treat immunodeficiencies. One is a new code and one is a revision of an existing code.

New: Intravenous IG (IVIG) product Gammaplex gets its own 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). According to the HCPCS agenda, the new code was requested because Gammaplex "differs from other licensed IVIG products in several significant respects that can affect product tolerability and safety."

2012 example: Staff administers a 2-hour, 16,350 mg Gammaplex infusion. You should 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 should report 96365 for the first hour of administration. For the second hour, 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]).

Revision: HCPCS 2012 also brings an adjustment to brand names and administration methods listed in J1561:

• 2011: J1561, Injection, immune globulin, (Gamunex), intravenous, non-lyophilized (e.g. liquid), 500 mg
• 2012: J1561, Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), non-lyophilized (e.g. liquid), 500 mg.

The revision was requested because the trade name changed from Gamunex to Gamunex-C. The 2012 definition also deletes the term "intravenous." Gamunex-C may be administered either intravenously or subcutaneously.

The 2012 code makes the code applicable to administration of Gammaked, too, which staff may administer either intravenously or subcutaneously.