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Urology Coding Alert

CCI 18.1:

Q2043/96365 Bundle Bit the Dust on April 1

Published on Wed Apr 11, 2012

Nab your chance to resubmit claims for Provenge administration pay. Finalizing the official rules for Provenge coding seems to be an ongoing project for Medicare. First, Medicare said you couldn't report an administration code with Provenge code Q2043 (Sipuleucel-T minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion). Then, even after CMS changed that rule, a Correct Coding Initiative (CCI) edit bundled certain administration codes into Q2043. Good news: Your claims for this prostate cancer therapy should have smoother sailing now that CCI has implemented much needed edit deletions for physicians. Take Advantage of Retroactive Deletion CCI version 18.1, effective April 1, 2012, deletes edits bundling the following codes into Q2043: 96360, Intravenous infusion, hydration; initial, 31 minutes to 1 hour 96365, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour 96372, Therapeutic, [...]
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