HCPCS: Q2048, Q2049 Will Stir Your Liposomal Doxorubicin HCL Coding This Summer

CMS would no longer be using J9001 for Doxil once the change happens in July.

One of the side effects of drug shortages is that coders have to determine which HCPCS codes to use for replacement drugs. While deciding how to report two substitution drugs accurately -- Lipodox and Fusilev – you must consider these recent updates from CMS and Noridian Medicare.

Prepare to Use Q2049 This Summer

A shortage of Doxil has led to the temporary importation of a replacement drug, Lipodox. Both Doxil and Lipodox include a doxorubicin hydrochloride liposome injection.

CMS has declared new HCPCS codes for Lipodox and Doxil. The codes will become effective July 1, 2012.

As you can understand from the new codes’ definitions, they differentiate between Doxil and Lipodox:

• Q2048 (Injection, doxorubicin hydrochloride, liposomal, Doxil, 10 mg)
• Q2049 (Injection, doxorubicin hydrochloride, liposomal, imported Lipodox, 10 mg)

To make way for these new HCPCS codes, the July HCPCS update specifies it will revise Doxil’s current code J9001 (Injection, doxorubicin hydrochloride, all lipid formulations, 10 mg) and modify its coverage status to "I." That status means the code is not payable by Medicare (as of July 1).

HCPCS Codes Q2048 and Q2049 both show coverage status "C," demonstrating coverage is at the carrier’s discretion.

Prior to the announcement of the new codes, at least one payer, Noridian Medicare, had instructed its providers to report J9001 for imported Lipodox.

In the payer’s words: Doxil® (J9001) may be replaced with Lipodox® (J9001) which temporarily must be coded as J9001 -- until further notice," as per the March 20, 2012, announcement.

Uses: Physicians may order liposomal doxorubicin HCL to treat ovarian cancer when platinum-based chemotherapy has failed or to treat AIDS-related Kaposi’s sarcoma when chemotherapy has failed. An additional indication is combination with bortezomib (Velcade) to treat multiple myeloma when the patient has received prior therapy other than bortezomib.

Swap J0640 for J0641 for Leucovorin Replacement

Another drug shortage oncology coders have had to face involves leucovorin. The HCPCS codes and agents involved are as follows:

• Leucovorin: J0640 (Injection, leucovorin calcium, per 50 mg)
• Levoleucovorin (Fusilev): J0641 (Injection, levoleucovorin calcium, 0.5 mg)

Noridian spoke of this issue in the same March 20 announcement that discussed Lipodox. The contractor instructed its providers that "Leucovorin (J0640) may be substituted with levoleucovorin (J0641) until such time as the shortage is fixed.

Uses: Before you report either leucovorin or levoleucovorin, ensure that the documentation supports medical necessity. Leucovorin is only required in limited circumstances where folinic acid is required and the patient cannot use regular folate/folic acid. The physician may order it to counteract definite effects of methotrexate or enhance certain effects of 5-fluorouracil.