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Codes updated for aprepitant, rituximab, other agents for hematology and oncology
by Deborah Marsh
The 2019 version of the Healthcare Common Procedure Coding System Level II code set for reporting supplies and services to public and private insurers took effect Jan. 1.
The code set includes updates to several codes for drugs and other agents relevant to hematology and oncology practices.
It is important for clinicians and practice administrators to understand the code changes, as coding is linked to reimbursement from third-party payers.
To support accurate reporting of codes on claims, the nursing and charge entry staff responsible for calculating billing units should review the Healthcare Common Procedure Coding System (HCPCS) code changes.
Health care organizations also should update relevant coding and reimbursement resources, such as charge masters, charge forms and electronic billing systems.
This effort on the front end will save work in the long run because the team will not have to spend time correcting claims returned for using out-of-date codes and descriptors.
Below is a selection of 2019 HCPCS Level II code updates applicable to hematology and oncology.
Aprepitant — New code J0185 (Injection, aprepitant, 1 mg) applies to injectable aprepitant, which is used to prevent acute and delayed chemotherapy-induced nausea and vomiting (CINV). Code J0185 replaces the 2018 code, which was C9463.
The change from a code beginning with C to a code beginning with J is important because Medicare intends C codes for use by Outpatient Prospective Payment System (OPPS) hospitals. Certain other facilities, such as critical access hospitals (CAHs), can use C codes at their discretion. CAH is a designation that CMS gives to eligible rural hospitals to reduce their financial vulnerability and also keep essential services in rural communities, thereby ensuring access to health care in those areas.
In contrast, a wider range of providers — including physician offices — may report other codes, such as A codes and J codes.
Being able to report a code specific to the drug or agent simplifies reporting and reimbursement; however, it is important to emphasize that the existence of a code does not guarantee coverage or payment.
Bortezomib — There is a new code for bortezomib administered by injection. It is J9044 (Injection, bortezomib, not otherwise specified, 0.1 mg).
Relevant diagnoses include multiple myeloma and mantle cell lymphoma.
This new code must be distinguished from J9041 (Injection, bortezomib (Velcade), 0.1 mg).
Emicizumab-kxwh — A new code, J7170 (Injection, emicizumab-kxwh, 0.5 mg), represents emicizumab-kxwh (Hemlibra, Genentech), a monoclonal antibody used to address factor VIII deficiency among patients with hemophilia A.
Fosnetupitant and palonosetron — Code J1454 (Injection, fosnetupitant 235 mg and palonosetron 0.25 mg) represents drugs used to prevent acute and delayed CINV. This new code replaces C9033.
Hexaminolevulinate hydrochloride — New code A9589 (Instillation, hexaminolevulinate hydrochloride, 100 mg) allows the provider to report hexaminolevulinate hydrochloride (Cysview, Photocure), used in conjunction with cystoscopy. The code replaces C9275.
Lutetium Lu 177 dotatate — A9513 (Lutetium Lu 177, dotatate, therapeutic, 1 millicurie) has replaced the old code, C9031. Lutetium Lu 177 dotatate (Lutathera, Advanced Accelerator Applications) is approved to treat gastroenteropancreatic neuroendocrine tumors that are positive for the hormone receptor somatostatin.
Mogamulizumab-kpkc — A new code, C9038 (Injection, mogamulizumab-kpkc, 1 mg), is a C code for use by OPPS hospitals. Mogamulizumab-kpkc (Poteligeo, Kyowa Kirin) is a monoclonal antibody that treats Sezary syndrome and mycosis fungoides.
Rituximab — There are two new codes for rituximab. They are J9311 (Injection, rituximab 10mg and hyaluronidase) and J9312 (Injection, rituximab, 10 mg). The 2018 rituximab code, J9310 (Injection, rituximab, 100 mg), has been deleted.
This change is a good example of why noting the amount stated in the code descriptor is important. One billing unit of the 2018 code J9310 represented 100 mg, but the 2019 codes represent 10 mg per billing unit.
Checking for changes like this in updates helps ensure that claims do not overreport or underreport the amount being billed.
Overreporting units may lead to overpayment, which the provider must return to the payer. Underreporting units may result in reduced initial reimbursement and rework once the problem is discovered. Both overreporting and underreporting may raise questions during a claim audit.
Rolapitant — The new code for injectable rolapitant (Varubi, TerSera Therapeutics) is J2797 (Injection, rolapitant, 0.5 mg). This replaces C9464. Rolapitant is used to prevent delayed-phase CINV.
The codes above are listed in the 2019 update of the HCPCS Level II code set, but health care organizations must watch for quarterly updates — which take effect Jan. 1, April 1, July 1 and Oct. 1 — to ensure they are using the most current version of HCPCS.
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Deborah Marsh, JD, MA, CPC, CHONC, works on a wide range of TCI SuperCoder projects, researching and writing about medical coding. She received her certified hematology and oncology coder (CHONC) credential from AAPC in 2010. She has covered the ins and outs of coding for several specialties, including oncology and hematology, orthopedics and audiology.
Disclosure: Marsh reports no relevant financial disclosures.