Oncology & Hematology Coding Alert

Account for drug wastage and don’t forget the procedure codes.

You could be forfeiting deserved pay for J9025 (Injection, azacitidine, 1 mg) if you’re under-reporting the units for azacitidine. And not adding the correct procedure and diagnosis codes can further compromise your reimbursement. Work through the exercise below to hone your azacitidine reporting skills. 

What is azacitidine? Azacitidine is a nucleoside metabolic inhibitor that is used as an antineoplastic agent. It is administered by subcutaneous injection or intravenous infusion routes.

Example: You may read that your physician administered 170mg of azacitidine intraveneously to a patient with high grade myelodysplastic syndrome (MDS). The infusion ran continuously and was mixed in 500 ml of normal saline over 40 min. The nursing also staff documented that 30mg of azacitidine was wasted from the second single dose vial used. 

How Would You Handle It? Take This 3-Questions Skills Test

Assess for Drug Wastage: Understanding how to report the right number of units for J9025 is fundamental to payment. The good news is that the calculation of the units is simple:  You report 1 unit of J9025 for every 1 mg of azacitidine.

For the example above, the first step is to calculate the number of units that you should report. 

Question 1: What HCPCS code(s) do you report for the azacitidine administration?

a) J9025
b) J9025 x 200 (or J9025 x 170 and J9025/JW x 30)
c) J9025 x 170, J7040
d) J9025 x 200, J7040

The correct answer: B. J9025 x 200.

1 mg implies 1 unit of J9025: In the example cited above, you report 170 units of J9025 for the drug administered. However, you would risk losing payment if you do not pay attention to wastage.

Tally your wastage: Azaciticidine (VIDAZA) is available in vials of 100 mg. Thus, your physician would use two vials to administer 170 mg to the patient. In the example above, the remaining 30 mg would be reported as wastage when supported as documented. According to Medicare policy, when drug wastage occurs, you should report the total units of medication in the claim, i.e. you report both dose administered as well as dose wasted. 

Carriers vary on the appropriate filing of the total units.  You may be required to report one line with the total amount (200 units) or two lines, one for the administered amount (170 units), and the second line for the wasted portion (30 units). Thus, in the example cited above, you should report 200 units of J9025.

Do not report incidental hydration: You would not report code J7040 (Infusion, normal saline solution, sterile [500 ml=1 unit]). This is because your physician did not administer the saline for the purpose of hydration. Your physician rather administered the infusate containing the medication. Fluids used to administer drugs are considered as incidental hydration and would not be reported separately, According to CPT®.

Check Timing of Infusion for Procedure Codes

Question 2: What is the procedure code that you can report?

a) 96413, 96361
b) 96360
c) 96413
d) 96417

The correct answer is 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug). 

You would not report CPT® code +96417 (Chemotherapy administration, intravenous infusion technique; each additional sequential infusion [different substance/drug], up to 1 hour [List separately in addition to code for primary procedure]), as it was the only infusion administered in the example and therefore the initial service.  

Additionally, the infusion of azacitidine lasted less than an hour (40 minutes). You would also not report hydration separately when your physician administers saline to deliver the medication. Thus, it is not appropriate to report code 96360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour).

Report Chemotherapy Encounter as First Listed ICD-9-CM Code

Question 3: Which of the following ICD-9-CM codes would you report?

a) V58.11, 238.75
b) V58.11, 238.74
c) V58.11, 238.73
d) V58.11, 238.72

The correct answer: C. V58.11 (Encounter for antineoplastic chemotherapy), 238.73 (High grade myelodysplastic syndrome lesions). The patient is seeing your physician for chemotherapy, so you report V58.11 as the first listed code followed by code 238.73 for the high grade MDS.