Oncology & Hematology Coding Alert

Question: Why have we been getting denials for J9033 provided to SNF patients even though we get reimbursed for other chemotherapy HCPCS codes?

New Mexico Subscriber

Answer: You've discovered an error in the Skilled Nursing Facility (SNF) Consolidated Billing File.

Code J9033 (Injection, bendamustine HCl, 1 mg), which represents Treanda, should have been included in the January 2012 "File 1 -- Part A Stay -- Physician Services" at www.cms.gov/Medicare/Billing/SNFConsolidatedBilling/2012Update.html. Being listed in that file would show the code is not subject to SNF consolidated billing for Medicare patients in a SNF Part A covered stay. Instead, physicians should submit the code to their Part B MAC for reimbursement.

Medicare is aware of the problem and will correct the edit in the Oct. 1, 2012, file. The change will be retroactive to Jan. 1, 2012.

What to do: To get J9033 reimbursement before the October correction, you should contact your MAC or carrier to reopen and reprocess the affected claims.

For instance, J4 MAC Trailblazer has posted instructions for providers either to call the telephone reopening line or to submit a written request via the reopening request form (www.trailblazerhealth.com/Tools/Notices.aspx?ID=14994).

You can review the official instruction from CMS, Transmittal 2492, at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2492CP.pdf.