If your practice reports oral anti-emetics, be sure that you stay on top of ondansetron reporting news or you could be meeting denials this year.
Effective Jan. 1, 2012, if your physician administers Ondansetron, you should report it using Q0162 (Ondansetron 1 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen).
To accommodate Q0162, HCPCS deleted Q0179 (Ondansetron hydrochloride 8 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen), says Janae Ballard, CPC, CPC-H, CPMA, CEMC, PCS, FCS, coding manager for The Coding Source.
What it means for you: Reporting Q0179 for a 2012 date will bring an instant denial. You should use Q0162 instead.
Zuplenz Factors Into Unit Change
Pay attention to how the code change affects unit reporting, Ballard says. For 2011’s Q0179, one unit represented 8 mg; however, in 2012, one unit of Q0162 represents only 1 mg.
This will help more accurate reporting of the ondansetron oral soluble films sold as Zuplenz. The films are available in 4 mg and 8 mg doses. Although codes specific to the oral films were requested, the new code was introduced so that it could “be assigned to any oral dose form available,” states the May 17, 2011, HCPCS Public Meeting Agenda (www.cms.gov/MedHCPCSGenInfo/downloads/Tues_May17thDrug-Agenda.pdf).
Refresh Your Know-how on Oral Anti-Emetic Rules
Pay attention before you report Q0162,. “There is a specific set of guidelines for oral anti-emetics to be considered payable by Medicare,” says Lisa S. Martin, CPC, CIMC, CPC-I, chargemaster specialist for OSF Healthcare System in Peoria, Ill.
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