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Local Coverage Determination

Article Coding Guideline

Link to LCD

CONTRACTOR INFORMATION

Contractor Name

CareFirst of Maryland, INC., Medicare Part A

Contractor Number

00190

Contractor Type

Fiscal Intermediary

ARTICLE INFORMATION

Article Database ID Number

 A22454

Article Type

General

Article Version Number

Article Title

 Irinotecan

Is the AMA/CPT and ADA/CDT Copyright Statement Required?
Yes

CPT codes, descriptions and other data only are copyright 2003 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. CDT-4 codes and descriptions are © 2003 American Dental Association. All rights reserved.

Primary Geographic Jurisdiction

Maryland

Washington, DC

Secondary Geographic Jurisdiction

Alabama, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, Washington state, and Wyoming

Article Publication Date

Article Beginning Effective Date

Article Text

LCD Description

Irinotecan is an intravenous antineoplastic agent.

Coding Guidelines

 All of the coverage criteria must be met before this service can be reimbursed by Medicare.

· J9206 should be billed with revenue code 636.

· The units field on a claim is utilized as a multiplier to arrive at a dosage amount based on the dosage in the descriptor for the code. For example, J9206 describes a dosage of 20 mg. For a total dosage of 60 mg, a facility should bill “3” units in the units field.

· Administration of J9206 should be billed using revenue code 335 and Level II HPCPS code Q0084, chemotherapy administration by infusion technique only, per visit. Do not use CPT-4 codes for chemotherapy administration.

· All of the coverage criteria must be met before this service can be reimbursed by Medicare.

· Diagnosis (es) must be present on any claim submitted, and be coded to the highest level of specificity.

· The diagnosis codes(s) must be representative of the patient's condition.

· Diagnosis (es) must be present on any claim submitted, and be coded to the highest level of specificity.

Reasons for Denial

· All other indications not listed in the "Indications and Limitations of Coverage" section of this policy,

· The service is considered:

· to be for screening purposes,

· investigational,

· not medically necessary;

· cosmetic purposes.

· The medical record does not verify that the service described by the HCPCS code was provided, and;

· The service does not follow the guidelines of this policy.

Coverage Topic

Chemotherapy (Outpatient)

Outpatient Hospital Services

Other Comments

· When billing for the administration of the drug, use the appropriate alphanumeric code, Q0084, revenue code 335. HCPCS codes 96400-96540 should not be billed to report chemotherapy, as they are non-reportable HCPCS codes.

· Services not separately billable-Flushing of a vascular access port prior to administration of chemotherapy, port access, portal exit, is integral to the chemotherapy administration and is not separately billable. If a special visit is made for the port flushing, use code 99211, brief office visit.

· This information was originally contained in the LMRP prior to its conversion to an LCD. 

Does this Article contain a "Least Costly Alternative" provision?

No

THIS BULLETIN SHOULD BE SHARED WITH ALL HEALTH CARE PRACTITIONERS AND MANAGERIAL MEMBERS OF THE PROVIDER/SUPPLIER STAFF. BULLETINS ISSUED AFTER OCTOBER 1, 1999 ARE AVAILABLE FROM OUR WEBSITE AT www.marylandmedicare.com