After July HCPCS Updates, Match These Meds to Correct Codes Faster

coding HCPCS for drugs and supplies

Thinking about summer? You aren’t the only one! CMS has posted a file with five Q codes that will be effective July 1, 2018. If you code for any of these supplies, plan ahead so you’re ready to change your coding when July comes.

Watch mg to Separate SublocadeTM Codes for Opioid Use Disorder

First is a set of two related codes for Sublocade, which is indicated for the treatment of moderate to severe opioid-use disorder in adult patients. Note the difference in amount administered, shown at the end of each descriptor (bold added):

  • Q9991 (Injection, buprenorphine extended-release (Sublocade), less than or equal to 100 mg)
  • Q9992 (Injection, buprenorphine extended-release (Sublocade), greater than 100 mg).

You typically may see two once-monthly doses of 300 mg followed by 100 mg maintenance doses each month.

Diagnosis codes you may connect to these codes are likely to be in the F11.2- (Opioid dependence) subcategory, with some payers expanding that list to subcategories like F11.1- (Opioid abuse) and F11.9- (Opioid use, unspecified).

There’s a decent chance your payer has a specific policy for Sublocade, so be sure you’re familiar with the ones that apply to your patients and providers.

The Medicare coverage status for these codes will be C, meaning carrier judgment determines coverage.

Turn to Q9993 for Zilretta® Knee Treatment

The next code to know is Q9993 (Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg).

There’s no drug name specified in the descriptor, but you can expect to use it for Zilretta, an extended-release corticosteroid injected into the knee to treat pain from osteoarthritis.

The diagnosis codes you’ll see for patients getting the treatment will likely be under M17.- (Osteoarthritis of knee).

The coverage indicator for this code will be D, which means special coverage instructions apply.

More changes ahead? Watch to see whether recently added code C9469 with the exact same descriptor will get deleted when the Q code is added. C codes are for use by OPPS hospitals, so physician offices cannot report C9469. But physicians (and others) will be able to use the new Q code. The manufacturer has filed a request for a more permanent J code (Q codes are temporary), so you may see another code change in January 2019.

Be Aware of New RelizorbTM Enteral-Feeding-Related Code Q9994

The next new code in the file is Q9994 (In-line cartridge containing digestive enzyme(s) for enteral feeding, each). This appears to connect to Relizorb. For an explanation of why the company wanted a separate code for this item, head to page 32 of the HCPCS Public Meeting Agenda from June 8, 2017.

In short, it’s a cartridge filled with a digestive enzyme that fits between an infusion pump and feeding tube. It modifies fats to make them more absorbable, such as in patients with cystic fibrosis.

The coverage indicator will be I, meaning it’s not payable by Medicare.

Move Away From Unclassified Codes for Hemlibra®

The final new code in the currently available update file is Q9995 (Injection, emicizumab-kxwh, 0.5 mg).

The brand name you can expect to see associated with this code is Hemlibra, a medicine prescribed to patients with hemophilia A to prevent and reduce bleeding episodes.

The diagnosis code you’re likely to see in connection with this medication is D66 (Hereditary factor VIII deficiency).

The coverage indicator will be C, so check specific payer policies for coverage information.

What About You?

Do you report any of these supplies? Do you see the addition of specific codes as a positive thing?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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