If
your practice reports anti-emetics, there’s a new HCPCS code for oral
chlorpromazine hydrochloride that you should be using in 2014 — Q0161 for 5 mg
dose of chlorpromazine over a 48 hour period.
Know This: For
chlorpromazine, you submit claims using a Q code. Make sure that your physician
indicates on the order that the beneficiary is getting the oral antiemetic
drug(s) as full therapeutic replacement for an intravenous anti-emetic drug as
part of a cancer chemotherapeutic routine. This is a mandate for the Medicare
benefit.
Remember these key tips
when reporting the new code for oral anti-emetic:
- Ensure that it is for complete therapeutic replacement: Medicare pays for oral anti-emetic drugs when used as full therapeutic replacement for intravenous dosage forms as part of a cancer chemotherapeutic regimen. It must be prescribed by a physician for use immediately within 48 hours post the time of administration of the chemotherapeutic agent.
- Remember the 48 hour period: The allowable period of covered therapy includes the date of service (DOS) of the chemotherapy drug (counting the first day beginning during the treatment) and a period not to surpass a couple of additional calendar days, or a maximum period up to 48 hours.
- Document the chemotherapy: Remember, you should report the oral anti-emetic drug(s), prescribed by your physician, only on a per-chemotherapy-treatment basis. In this case, you report V58.11 (Encounter for antineoplastic chemotherapy) as your primary diagnosis code. This confirms that the patient presented for chemotherapy.
- Watch the units: For 5 mg of chlorpromazine, you report one unit of Q0161
These drug codes are often overlooked or used
improperly; so it’s always helpful to have an online tool that helps to find
the latest HCPCS codes quickly. For instance, here’s an example of an online
tool that helps users quickly look up HCPCS codes and displays instant results on
one page as shown in screenshot below:
To see how this HCPCS code look
up tool works, take a free trial here:
