Oncology & Hematology Coding Alert

The 2012 examples show which new drug code you're likely to pair with a push admin code.

HCPCS has three all new J9xxx codes available for 2012 dates of service. Jevtana, Halaven, and Yervoy all now have specific codes you can report when your practice supplies those drugs.

How to prepare? Be sure to update your charge master, electronic dictionaries, and charge slips to reflect any code and/or unit changes. "It is also a good idea to review code and unit changes with nursing staff and/or charge entry staff, depending on who is calculating the billing units ... This will eliminate rebills or pay backs for incorrect billing," says Janae Ballard, CPC, CPC-H, CPMA, CEMC, PCS, FCS, coding manager for The Coding Source, based in Los Angeles. And if drug unit calculations are performed electronically, ensure those fields are up to date in the charge master or electronic billing system so the quantity is correctly reflected in billing.

Smart move: The code changes are effective Jan. 1, 2012, so complete your updates and education before that date to eliminate errors, Ballard advises.

J9043 Applies to New Prostate Cancer Treatment

Cabazitaxel will get a specific code for 2012: J9043, Injection, cabazitaxel, 1 mg. There was no unique HCPCS code to report cabazitaxel in 2011.

The brand name you'll see associated with this anti-cancer medication is Jevtana. Physicians order it, typically combined with daily oral prednisone, to treat metastatic prostate cancer that has progressed despite previous treatments, including docetaxel (J9171, Injection, docetaxel, 1 mg).

2012 example: Thirty minutes after the patient takes oral pre-medications (antihistamine, corticosteroid, and H2 antagonist), staff administers 47.25 mg of Jevtana via 1-hour infusion. You should report 48 units of J9043 for the Jevtana supply and 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the administration.

Expect to Pair J9179 With IV Push Code

If your practice provides Halaven injections, take note of new code J9179 (Injection, eribulin mesylate, 0.1 mg). Eribulin mesylate also did not have a specific code in 2011.

Physicians may order eribulin mesylate (sold as Halaven) to treat "locally advanced or metastatic breast cancer in patients who have previously received at least two chemotherapeutic regimens, including an anthracycline and a taxane," states the May 17, 2011, HCPCS Public Meeting Agenda (www.cms.gov/MedHCPCSGenInfo/downloads/Tues_May17thDrug-Agenda.pdf).

2012 example: Staff administers 2.41 mg of Halaven by a 4-minute IV push. Report the supply with 25 units of J9179, and report the administration using 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug).

HCPCS Says Yes to J9228 for Yervoy

You'll also have a new 2012 code for ipilimumab, sold as Yervoy: J9228, Injection, ipilimumab, 1 mg. HCPCS did not offer a specific code for ipilimumab in 2011.

The -- mab at the end of ipilimumab helps to identify it as a monoclonal antibody. "Yervoy is indicated for the treatment of unresectable or metastatic melanoma," the Agenda states.

2012 example: Staff administers 210.93 mg of Yervoy via a 90-minute IV infusion. You should report 211 units of J9228 for the drug. For the administration report 96413, which covers the first hour plus up to an additional 30 minutes of administration time, a total of 90 minutes. (CPT® requires at least 31 additional minutes to report +96415, ... each additional hour [List separately in addition to code for primary procedure], so you should not report +96415 in this example which involves a 90-minute infusion).