Oncology & Hematology Coding Alert

Check what the latest edition of Sentinel Event Alert from Joint Commission says about misuse of vials.

The latest HCPCS code update – which became effective July 1, 2014 – changed the way you report some morphine and propofol administrations. Review these J and S codes that you should have added to your HCPCS mix.

Morphine Status Indicators Get a New Change

The previous J code for morphine frequently used in epidural or intrathecal injections (J2275, Injection, morphine sulfate [preservative-free sterile solution], per 10 mg) was replaced for Medicare by Q9974 (Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg). Code Q9974 was introduced as a temporary code for HCPCS 2014 with a planned implementation date of July 1. 

“Your physician may use the Q code to bill Medicare the commercially prepared morphine used to refill an implanted infusion pump in an office place of service,” says Marvel Hammer, RN, CPC, CCS-P, ACS-PM, CPCO, owner of MJH Consulting in Denver, Co. Even though the J2270 (Injection, morphine sulfate, up to 10 mg) code remains valid for Medicare, coders should check with their provider to ensure the correct HCPCS code is billed. Your physician may often use preservative-free drugs for epidural or intrathecal injections.

Another change: Two of the HCPCS “J” codes used to bill for morphine administered by injections now have a Medicare HCPCS coverage status indicator of “I” instead of the previous assignment of “D.” Indicator “I” means the code is “Not valid for Medicare purposes” with no implementation grace period. 

The codes that were newly classified with the “I” Medicare coverage status are J2271 (Injection, morphine sulfate, 100 mg) and J2275 (Injection, morphine sulfate [preservative-free sterile solution], per 10 mg).  

Watch for When New S0144 Might Apply

Another change of interest is the new S code for propofol (S0144, Injection, Propofol, 10 mg). Your providers can turn to S0144 when they administer propofol for monitored anesthesia care (MAC) during a procedure in a non-facility site of service. Your provider may provide these services to patients with terminal stage of cancers.

The new S0144 code should not be reported to Medicare and likewise has a Medicare HCPCS coverage status of “I” or “Not valid for Medicare purposes.”

Providers Need To Check With Other Payers

With these types of mid-year HCPCS new code implementation and/or coverage changes, Hammer advises that practices check with their non-Medicare payers as not all update their HCPCS files every quarter as Medicare does. It is possible the new Q9974 or S0144 HCPCS codes may not be implemented on July 1, 2014 by all non-Medicare payers.

Bonus: Exercise Proper Procedures for Medication Vial Usage

In other interesting news, the latest edition of Sentinel Event Alert from Joint Commission focuses on preventing infection from the misuse of vials. 

According to the report, “Thousands of patients have been adversely affected by the misuse of single-dose/single-use and multiple-dose vials. The misuse of these vials has caused harm to individual patients through occurrences and outbreaks of blood borne pathogens and associated infections, including hepatitis B and C virus, meningitis, and epidural abscesses. Adverse events caused by this misuse have occurred in both inpatient and outpatient settings, according to the Centers for Disease Control and Prevention (CDC).” 

More information: Download the report at http://www.jointcommission.org/assets/1/6/SEA_52.pdf to verify you’re following correct procedures or to learn what precautions you should implement.