See What’s New for HCPCS Level II J and Q Codes in 2020

You’re using ICD-10-CM 2020, and you’ve had some time to prepare for CPT® 2020. But now the HCPCS Level II 2020 code set is out for medical coders to review, too! Let’s take a look at some J and Q code changes coming your way Jan. 1, 2020.

The Os Have It! Ophthalmology and Oncology Get New Codes

We’ll start with three new J codes. A J code is a HCPCS Level II code that starts with the letter J and represents the supply of a drug.

First, optometry and ophthalmology coders will need to know new code J0179 (Injection, brolucizumab-dbll, 1 mg).

This code represents the supply of Beovu®, which is indicated for treatment of wet age-related macular degeneration (AMD). FDA approval for the drug was announced in October. The physician injects the drug into the eye (intravitreal injection). The recommended dose is 6 mg, so be careful when reporting units. You’ll need 6 units of J0179 to represent 6 mg administered.

Next, oncology coders should be aware of J9199 (Injection, gemcitabine hydrochloride (Infugem), 200 mg).

The code descriptor lists the trade name InfugemTM, a product that includes the chemotherapy drug gemcitabine in a premixed formulation that is ready to use for infusion. Physicians prescribe gemcitabine to treat pancreatic cancer and in combination with other drugs to treat advanced ovarian cancer, metastatic breast cancer, and non-small cell lung cancer. The dosage may vary by diagnosis and other factors, so match your units to the documentation, and do the math to report 1 unit per 200 mg.

In tandem with the creation of new code J9199, you will see a revision to the existing gemcitabine code.

  • 2019: J9201 (Injection, gemcitabine hydrochloride, 200 mg)
  • 2020: J9201 (Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg)

The final new J code we will cover is also one oncology coders will use: J9309 (Injection, polatuzumab vedotin-piiq, 1 mg).

You’ll use this code for PolivyTM. Physicians prescribe this immunotherapy to treat diffuse large B-cell lymphoma, the most common type of non-Hodgkin lymphoma. Patients receive this antibody-drug conjugate in combination with bendamustine (chemotherapy) and a rituximab (monoclonal antibody) product. Polivy comes in a 140 mg single-dose vial, and you will report 1 unit per 1 mg.

Understand Small Change to Epoetin Codes

Two related Q codes will see minor changes, adding “-epbx” in the 2020 code set descriptors to better match the generic name for RetacritTM.

  • Q5105 (Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for esrd on dialysis), 100 units)
  • Q5106 (Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for non-esrd use), 1000 units)

The -epbx was included in the suggested language for the Retacrit codes in the initial application, but was not used in the original code descriptors.

Retacrit treats anemia caused by chronic kidney disease, chemotherapy, and HIV medication. The revision adds only those few letters (-epbx), which means the units stay the same with 1 billing unit per 1,000 units of medication.

HCPCS Level II Q codes are temporary codes, so these codes may get replaced by codes in another section of the code set in the future.

What About You?

The changes above are effective Jan. 1, 2020, but many of the HCPCS Level II codes Medicare lists as new for the 2020 update are codes you should already be using. That’s because the codes were added during quarterly updates in 2019. Do you update your HCPCS Level II coding every quarter?

About 

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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