Oncology & Hematology Coding Alert

Question: The J code for Taxol per 30 mg is J9265. The code was not changed when the drug went from a single-dose vial to a multidose one. I have heard that many coders are rounding this to the nearest 30 mg. We have been billing to the closest 30 mg and then coding the remainder under J9999. For example, for a 164-mg dose, we bill J9265 x 5 and J9999 x 14. Is this correct?

Arizona Subscriber

Answer: Some drugs have multiple J codes (drug codes) for different quantities. You should accurately describe the dosage administered through a combination of codes. For example, Etoposide has two codes, J9181 for 10 mg, and J9182 for 100 mg. When 150 mg of Etoposide is provided, bill one unit of J9182 and 5 units of J9181. Other drugs, however, have only one J code. Taxol is an example of this.

In this case you would use the quantity associated with the J code to describe how much was administered. For example, a 120-mg dose should be coded as J9265 x 3. If the amount given from a multidose vial falls between multiples of the J code amount, most oncology practices round up to the next vial to avoid out-of-pocket losses. A 110-mg dose should also be coded as J9265 x 3.

Medicare policy is a bit unclear on how to handle wasted drugs from multidose vials. Rounding up is an accepted practice among most Medicare payers. Code J9999 (not otherwise classified, antineoplastic drug) is generally used when a new antineoplastic agent has been released and a J code has not been assigned. Rather than assigning the remainder of the unused portion of a multidose vial as J9999, you should be rounding up to the next highest multiple of that drug.

Answered by Elaine Towle, CMPE, practice administrator for New Hampshire Oncology Hematology in Hooksett, N.H.