Wiki Q0162 verses S0119 - appropriately code

[cdr4life]

Hello,

I would like someone to please let me know how to appropriately code for Zofran, when it is given orally to our patients. We received a denial stating Medicare patients need to be coded differently. Non medicare would be S0119, Medicare would be Q0162, correct? In the HCPCS book it says to use this code for Zofran. It also states in the HCPCS description for Q0162: not to exceed 48 hours dosage regimen, for use complete substitute (therapeutic) for an IV at the time of chemo therapy, etc.

Does this mean i can only use this code for chemo therapy, IV use?! Can someone please let me know?

Thank you,

Stephanie Garrison, CPC
Medical Biller and Coder
Good Health Financial, PC
4600 S. Mill Avenue, Ste 280
Tempe, AZ 85282-6850
sgarrison@goodhealthfinancial.com

 

[shellysk8]

Q0162 verses S0119

Hi,

Per the HCPCS code definition, Q0162 can only be used if given as an antiemetic treatment due to chemotherapy induced nausea. If the cause is other than chemotherapy, then S0119 must be used for Zofran/odansetron. This would not only be for Medicare patients, but for all payers (unless instructed otherwise via a payment policy).

I hope this helps!
Shelly
Shelly L. Kubacki, MPA, CPC

 

[cdr4life]

thanks!

Hi,

thanks so much for that response. I now know only some payers with reimburse for S0119.

Thank you,

Stephanie Garrison, CPC
Medical Biller and Coder
Good Health Financial, PC
4600 S. Mill Avenue, Ste 280
Tempe, AZ 85282-6850
sgarrison@goodhealthfinancial.com