Oncology & Hematology Coding Alert

Question: When a national coverage determination doesn't specify which codes to use, how do we know which particular codes apply?

Nevada Subscriber

Answer: When a national coverage determination (NCD) doesn't list specific codes for use, your next step should be to check for a local coverage determination (LCD) or local payer policy.

For example: Palmetto GBA offers a list titled "J1 A/B MAC Palmetto GBA Assigned ICD-9-CM Codes for National Coverage Determinations." It doesn't supply codes for all NCDs, but it's a good starting point for J1 providers. It features codes for items including:

• Anti-Inhibitor Coagulant Complex (AICC)
• Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer
• Intravenous Iron Therapy
• Stem Cell Transplantation.

Check the list, and you'll see that covered codes for IV iron therapy include:

• 280.0, Iron deficiency anemia secondary to blood loss (chronic)
• 280.1, Iron deficiency anemia secondary to inadequate dietary iron intake
• 280.8, Other specified iron deficiency anemias
• 280.9, Iron deficiency anemia, unspecified
• 285.1, Acute posthemorrhagic anemia
• 285.21, Anemia in chronic kidney disease.

You can reach the site by starting at the J1 home page: www.palmettogba.com/palmetto/providers.nsf/DocsCatHome/Jurisdiction%201%20Part%20B. In the search box, enter "Assigned ICD-9-CM Codes for National Coverage Determinations." The results should show you the link for the NCD code list. Double check the codes before you report them to be sure they're valid for your claim's date of service.

Alternative: When a local payer doesn't define the covered codes, you'll need to compare the patient's case to the covered conditions listed in the NCD. You also may check CMS-approved compendia for anti-cancer medications. When in doubt, you also may contact your payer to obtain information regarding whether treatment for the patient's condition will be covered. For more information on the approved CMS compendia, check out the information at the following link: www.cms.gov/CoverageGenInfo/02_compendia.asp.

Remember: Documentation must support your code choice. You should never choose a code simply because you know it will support reimbursement.