Friday, May 2, 2014

Report HCPCS Code for Oral Anti-Emetic - Q0161- with Confidence


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: 

  1.   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.   
  2. 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.
  3. 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.
  4. 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: