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Remember to check your payer's self-administered drugs list to prevent denials.

Coding for prostate, bladder, and other urologic cancer therapy involves its own set of challenges, such as finding drug and administration codes for hormonal anti-neoplastics. Give your claims a leg up with a closer look at common therapy agent codes and administration coding strategies.

Hang on to This Handy HCPCS List

When coding for urologic oncology, you should familiarize yourself with the therapeutic agents your office uses most often. These may include the ones in the table below.

In addition to the drug HCPCS code, you should note the dosage or units administered. Also keep in mind that when you submit a claim for drug payments, in many cases the payer may require the full drug name, the total dosage or units administered, method of administration, and the National Drug Code (NDC) number.

Tip: Before submitting a claim to your Part B contractor, be sure to review its latest list of the drugs it won't cover because it considers them to be typically self-administered. For instance, you may find that your contractor won't cover luteinizing hormone-releasing hormone (LHRH) analogs coded with J9218 (Leuprolide acetate, per 1 mg) or J1675 (Injection, histrelin acetate, 10 micrograms) because patients usually can perform their own injections of these agents.

Remember That LCA Is Out for Reimbursement

In the past, some payers including Medicare would adjust your payment for drug codes down to the same level as the drug within the same classification with the lowest Average Sales Price (ASP). This was also known as applying the Least Costly Alternative (LCA).

The LCA policy said that if you have two products and both products produce similar acceptable results, but one product price is higher than the other, the reimbursement will be the cost of the lower priced product, explains Maggie Mac, CPC, CEMC, CHC, CMM, ICCE, president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla. and Brooklyn, N.Y. In other words, payment was based on the idea that if there was no substantive evidence that the higher priced product produced superior results, then there was no need to use it and the lower priced product should have been utilized. Therefore, reimbursement [would] only be as high as the 'least costly alternative.'

However, following a ruling by the US Court of Appeals, CMS released a directive effective April 19, 2010, that MACs were required to stop using LCA for all Part B drugs and were restricted from implementing LCA in any new LCDs. As a result, payers should now be reimbursing you using ASP-based payment rates (See also: Medicare Claims Processing Manual, Chapter 17, Section 20,