Health Information Management

Q&A: Are we using the correct mitomycin code?

APCs Insider, April 25, 2014

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Q: One of our ophthalmologists orders mitomycin after his surgeries. We have a charge number for our oncology department that reports HCPCS code J9280 (injection, mitomycin, 5 mg), and we have been using that line item for surgery, too. One of our pharmacists is not sure this is correct. Any thoughts?
A: There are two HCPCS codes for mitomycin:
  • J7315, mitomycin, ophthalmic, 0.2 mg
  • J9280, injection, mitomycin, 5mg
HCPCS code J7315 is specific to the ophthalmic formulation of mitomycin and should be used for topical application. HCPCS code J9280 is reported for the injection. In the April 2014 OPPS update, CMS provides further billing guidance for mitomycin used topically during or after ophthalmic surgery. Transmittal 2903 notes:
J7315 may be reported only if the hospital uses mitomycin with the trade name Mitosol®. Any other topical mitomycin should be reported with J3490. Hospital outpatient departments are not permitted to bill HCPCS code J9280 for the topical application of mitomycin.
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman and founder of Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

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