Health Information Management

Q&A: Why is a drug being removed from our CDM?

APCs Insider, September 26, 2014

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Q: Our charge description master (CDM) manager wants to remove the code for denileukin from our CDM, as the status is changing. Why is this happening?
 
A: CMS is changing the status indicator for the HCPCS code for denileukin (J9160), effective October 1. The status indicators for J9160 and J9300 (gemtuzumab ozogamicin) are changing from K (non pass-through drugs and biologicals, and blood and blood products) to E (not paid by Medicare when submitted on outpatient claims) because the products are no longer marketed.
 
CMS noted the availability in MLN Matters® article 8880, the October 2014 update for ambulatory surgery centers (the transmittal for the October OPPS update for hospital providers is available in a separate file).
 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.



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