Oncology & Hematology Coding Alert

Question: A patient received Vectibix before J9303 was introduced, so we submitted the claim to Medicare with J9999. We are still getting denials for the original claim. Should we change the code?

Massachusetts Subscriber

Answer: Because J9303 (Injection, panitumumab, 10 mg) was not in effect on the date of service, your wisest move is to continue seeking reimbursement with J9999 (Not otherwise classified, antineoplastic drugs). Submit your appeal with the office visit notes from the day of chemotherapy (if any), the physician's order, the chemotherapy flow sheet, and the medication's NCD number. Be especially diligent about noting the date of service as the reason for reporting J9999 instead of J9303.

The drug code might not be the only reason for your denial, however. Double check that you-re not submitting a non-covered diagnosis and verify that there aren't other reasons for non-payment before continuing to appeal.