Health Information Management

Q/A: New HCPCS codes

APCs Insider, July 20, 2012

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Q:  CMS consistently replaces established HCPCS codes for drugs with new ones.  Did CMS make any changes as part of the July OPPS update?

A:  CMS has established some new HCPCS codes for July 1, and some of them do replace existing HCPCS codes.  The new codes are:
  • Q2045, injection, human fibrinogen concentrate 1mg
  • Q2046, injection, aflibercept, 1mg
  • Q2048, injection, doxorubicin hydrochloride liposomal, doxil, 10mg
  • Q2049, injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10mg
  • Q2034, influenza virus vaccine, split virus, for intramuscular use (Agriflu)
In addition to the codes changing, the measurement of the drug in the descriptor has changed, which will affect the number of units that coders should report.
For example, Q2045 replaces J1680 (injection, human fibrinogen concentrate, 100mg).  This creates a huge impact on the number of units that should be reported. If 100 mg are given, rather than reporting J1680 and 1 unit, coders will now report Q2045 and 100 units.  Someone in the pharmacy and other hospital outpatient departments must review the codes in detail with that charge for these drugs.  Incorrect reporting of units will have a huge impact for these items. 
Transmittal 2483 contains the listing in Table 3 along with the HCPCS codes and descriptors being replaced by the new codes.
Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

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