Health Information Management

Q&A: Can we report another HCPCS code for a drug not reportable to Medicare?

APCs Insider, May 2, 2014

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Q: We have a physician who is sending patients to our outpatient clinic to receive tbo-filgrastim. However, we have been unable to bill for this as a covered service because the HCPCS code (J1446) is not reportable to Medicare. Is there another HCPCS code we can report?
A: If there is a HCPCS code for a specific drug or substance, you should report that HCPCS code. HCPCS code J1446 was assigned to status indicator E in the January 2014 Addendum B. InTransmittal 2903, the April 2014 update to the OPPS, CMS published several changes to status indicators for drugs and biologicals:
  • J1446, injection, tbo-filgrastim, 5 micrograms, is changing from status indicator E to K
  • A9545, iodine I-131 tositumomab, therapeutic, per treatment dose, is changing from status indicator K to E
  • J7178, injection, human fibrinogen concentrate, 1 mg, is changing from status indicator N to K
  • Q0181, unspecified oral dosage form, FDA-approved prescription anti-emetic, will change from status indicator E to N.
These status indicators are defined as:
  • N, paid under OPPS, payment is packaged into payment for other services
  • K, paid under OPPS; separate APC payment
  • E, not paid by Medicare when submitted on OP claims (any OP bill type)
The effective date for the change is retroactive to January 1, 2014, for all except A9545, which is effective April 1, 2014. 
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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