Reimbursement Coding Information

This section provides possible reimbursement coding information for DACOGEN^® (decitabine) for Injection, according to site of service.

Although myelodysplastic syndromes (MDS) are classified as neoplasms of uncertain behavior, Medicare and most other third-party payers classify MDS treatment on the same basis as treatment of hematologic malignancies (e.g., leukemia).

• J Code 0894
• ICD-9 Code 238.72: Low grade myelodysplastic syndrome lesions
  • Refractory anemia (RA)
  • Refractory anemia with ringed sideroblasts (RARS)
  • Refractory cytopenias with multilineage dysplasia (RCMD)
  • Refractory cytopenias with multilineage dysplasia and ringed sideroblasts (RCMD-RS)
• ICD-9 Code 238.73: High grade myelodysplastic syndrome lesions
  • Refractory anemia with excess blasts-1 (RAEB-1)
  • Refractory anemia with excess blasts-2 (RAEB-2)
• ICD-9 Code 238.74: Myelodysplastic syndrome with 5q deletion
  • Excludes: constitutional 5q deletion (758.39) high grade myelodysplastic syndrome with 5q deletion (238.73)
• ICD-9 Code 238.75: Myelodysplastic syndrome, unspecified

Please review the following pages in this section for specific coding details by site of service:

• Physician Office Setting
• Outpatient Hospital Setting
• Inpatient Hospital Setting

For more information on DACOGEN reimbursement services, please contact our DACOGEN Patient Assistance and Reimbursement Program:

DACOGEN Patient Assistance and Reimbursement Program

Reimbursement Hotline: 1-877-644-6270
Available Monday-Friday
9 a.m. to 8 p.m. (Eastern Time)
www.Dacogen.com

All coding and claims used by a provider in seeking reimbursement must be accurate, complete and adequately documented in the applicable patient record. All services must be medically appropriate. It is always the provider's responsibility to determine and submit the appropriate codes for services that are rendered. Providers should contact third-party payors for specific information on their coding, coverage, and payment policies.

References

IMPORTANT SAFETY INFORMATION

DACOGEN may cause fetal harm when administered to a pregnant woman. Women of childbearing potential should be advised to avoid becoming pregnant while using DACOGEN. Men should be advised not to father a child while receiving treatment with DACOGEN, and for 2 months afterwards. The most commonly occurring adverse reactions include neutropenia, thrombocytopenia, anemia, pyrexia, fatigue, nausea, cough, petechiae, constipation, diarrhea, and hyperglycemia.

DACOGEN is available by prescription only. Please see the important product information for DACOGEN for more information. This site does not contain everything that is known about DACOGEN. If you would like to know more, talk to your healthcare professional.

This web site contains information relating to various medical conditions and their treatment. Such information is provided for educational purposes only and is not meant to be a substitute for the advice of a physician or other health care professional. You should not use this information for diagnosing a health problem or disease. Individual responses to DACOGEN treatment may vary.

This site is intended for health care professionals in the United States only. The products discussed herein may have different product labeling in different countries.

All information collected in this Web site is held in strictest confidence and will only be used for purposes as specified and will not be sold or distributed to other parties.