July 16, 2019
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from Deborah Marsh, senior content specialist for AAPC, a training and credentialing association for the business side of health care.
On July 1, 2019, several new HCPCS codes became available for reporting drugs and other agents. Payors will not accept outdated codes, so coders and clinicians need to be aware of these updates to ensure proper reporting and to avoid payment delays for claims.
The codes below are HCPCS Level II codes, specifically J codes and Q codes. J codes typically represent drugs that are not self-administered, inhalation solutions and chemotherapy drugs. Q codes are temporary codes that the Centers for Medicare & Medicaid Services (CMS) establishes to represent services and supplies that do not yet have a permanent code.
Trastuzumab code updates
Many of the HCPCS code changes effective July 1, 2019, are specific to trastuzumab, a monoclonal antibody used to treat breast cancer.
The descriptor for existing code J9355 added the phrase “excludes biosimilar,” changing from Injection, trastuzumab, 10 mg to Injection, trastuzumab, excludes biosimilar, 10 mg.
By adding “excludes biosimilar” to J9355’s descriptor, HCPCS sets J9355 apart from the following new codes that specify applicable brand names in parentheses:
- Q5112 Injection, trastuzumab-dttb, biosimilar, (Ontruzant), 10 mg
- Q5113 Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg
- Q5114 Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg
Another new code, J9356 Injection, trastuzumab, 10 mg and Hyaluronidase-oysk, provides a specific reporting option for Herceptin Hylecta.
For a better understanding of how these trastuzumab options vary, you can review the CMS HCPCS Public Meeting Agenda for May 14, 2019, which includes information about applications for these codes.
More oncology and hematology codes
In addition to the trastuzumab changes, there were several other HCPCS updates that will be of particular interest to those who code for the treatment of cancer and blood disorders.
Jivi, which treats and prevents bleeding in patients with hemophilia A, has new code: J7208 Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (Jivi), 1 i.u.
If you report BCG, note that Medicare contractors no longer accept J9031 BCG (intravesical) per instillation. However, there is a new BCG code, J9030 BCG live intravesical instillation, 1 mg. BCG is short for Bacillus Calmette and Guérin, a strain of mycobacterium. The clinical indication is for treating and preventing carcinoma in situ of the urinary bladder and prevention of primary or recurrent papillary tumors after transurethral resection.
You’ll use new code J9036 Injection, bendamustine hydrochloride, (Belrapzo/bendamustine), 1 mg for Belrapzo, which treats chronic lymphocytic leukemia and indolent B-cell non-Hodgkin’s lymphoma.
Finally, new temporary code Q5115 Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg gives you a specific code option for Truxima, used to treat adult patients with non-Hodgkin’s lymphoma.
Dialysis and COPD additions and deletions
The July 1, 2019, HCPCS code update also included codes related to dialysis and chronic obstructive pulmonary disease (COPD) treatment.
Dialysis providers should be familiar with new code J1444 Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron. The HCPCS quarterly update file includes a note to append modifier JE Administered via dialysate when appropriate. Existing code J1443 Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron also remains available after July 1 for that solution.
If you treat COPD, you should learn new code J7677 Revefenacin inhalation solution, FDA-approved final product, non-compounded, administered through DME, 1 microgram. This code applies to Yupelri Inhalation Solution.
Final tip: One of the top billing errors for HCPCS codes is reporting incorrect units. Be sure to pay attention to the amount in the specific code descriptor and calculate billing units accordingly. For example, you’ll report 1 billing unit of Q5115 for every 10 mg, but you’ll report 1 billing unit of J1444 for every 0.1 mg.