Part B Insider (Multispecialty) Coding Alert

Published on Tue May 18, 2010 PDF

coding for this drug during a recent audit, so ensure that you aren't making these mistakes.

On June 9, the OIG released its report, "Review of Medicare Part B Claims for Neulasta -- Wisconsin Physicians Service for the Calendar Years 2004 Through 2007," which revealed that WPS overpaid $655,149 for 462 claims submitted over the three-year audit period.

Neulasta, also known by its generic name Pegfilgrastim, is a chemotherapy drug that was previously billed using code Q4053, which referred to each unit size as 1 milligram. The code was later changed to J2505, which defined each unit as 6 milligrams. The conversion may have been the root of many coding problems, because some practitioners were simply accustomed to reporting six units of Q4053 and never made the conversion to reporting just one unit after J2505 was introduced.

The carrier "did not have sufficient edits in place during 2004 through 2007 to detect and prevent payments for such erroneous claims," the OIG report indicates.

After 2007, providers were subject to CMS's medically unlikely edits, or MUEs, which have caught some unit coding errors.

To read the complete OIG report, visit www.oig.hhs.gov/oas/reports/region5/50900070.pdf.