Wiki J0894 Dacogen - Correct infusion CPT code

[OCD_coder]

Hello all~

I am needing some feedback from experienced coders of oncology. I bill profee mostly for 5 oncology clinics. I am struggling to help one clinic manager understand that we should be billing therapeutic infusion codes when we give Dacogen J0894.

I have tried to explain that it is just like when we give Zometa J3487. We should be coding from the 96365-96367 code set depending on other drugs that are given and for how long, because based on the HCPCS catagory this is a therapeutic drug, not a J9XXX chemotherapy drug.

She is insistant that because it is called a "chemotherapy" drug that we have to use the chemotherapy code set 96411-96417 code set.

Any feedback would be welcome and if you have more information than the CPT guidelines, it would be much appreciated.

Thank you.

 

[btadlock1]

Here's an old LCD from find-a-code's website...

"To bill Palmetto GBA, submit the following codes:
• HCPCS code J0894 (Injection, decitabine, 1 mg)

• �CPT code 96413- Chemotherapy administration, IV up to 1 hour

• CPT code 96415- Chemotherapy administration, each additional hour

• �ICD-9-CM code 238.7- myelodysplastic syndrome (MDS).

History:
3/22/2007 Updated with new HCPCS code, removed narrative requirement for NOC code.

Coverage Topic:
Chemotherapy (Outpatient)"

And I also found this (it seemed informative)...
http://blogs.hcpro.com/revenuecycleinstitute/wp-content/uploads/2008/07/rci_sr1409_wp_03_09_web.pdf

Hope that helps!

 

[OCD_coder]

Thank you so much for your help.

But it goes against how I was orginally trained as "all chemo drugs are J9XXX codes and are to be billed with chemo infusion codes" "all drugs that do not start with J9XXX are to be coded with the therapeutic drug infusion codes."

And, this raises the question are we now incorrectly coding Zometa administration then as it is the identical situation?

By HCPCS definition J0894 is not a chemotherapy drug, but it is certainly classified as a antineoplastic drug by the drug companies.

Any thoughts on this information?

 

[btadlock1]

Thank you so much for your help.

But it goes against how I was orginally trained as "all chemo drugs are J9XXX codes and are to be billed with chemo infusion codes" "all drugs that do not start with J9XXX are to be coded with the therapeutic drug infusion codes."

And, this raises the question are we now incorrectly coding Zometa administration then as it is the identical situation?

By HCPCS definition J0894 is not a chemotherapy drug, but it is certainly classified as a antineoplastic drug by the drug companies.

Any thoughts on this information?

It has a status code of "K" which is "nonpass-through drugs and nonimplantable biologicals, including therapeutic radiopharmaceuticals." - I don't know if that's relevant or not, but - if the primary use of Zometa is as a chemotherapy drug, and especially if that's how it's being used, then you should go with the chemo codes. According to this website, it looks like it is...
http://www.chemocare.com/bio/

This isn't my strongest area, though, so I'd still check your LCD's before sending anything out.