Managing Sensipar in TIME – Clinical

Overview

With the Jan 1 TDAPA (Transitional Drug Add-on Payment Adjustment) rules, you’ll now need to manage your patients’ Sensipar prescriptions as these are now only payable on dialysis claims. TIME has been updated to handle the billing aspect of TDAPA, but Infian is still working on how best to assist our clients in managing Sensipar on the clinical side of TIME.

The latest guidance from CMS, ESRD PPS Transitional Drug Add-on Payment Adjustment, changes our initial thoughts on this. Essentially, when Sensipar is dispensed to the patient, you can only claim the number of days remaining in the month for the amount dispensed, with any remaining amounts added into subsequent claims. The example used in the document associated with the “ESRD PPS Transitional Drug Add-on Payment Adjustment” hyperlink shown above, has a patient receiving a 60-day fill on Jan 3rd. The January claim would have 29 units, the February claim would get 28 units, and the March claim would get the remaining 3 units. NOTE: The hyperlink also includes guidance on how to handle Sensipar when a patient dies as well as how to handle dosage changes.

Code Setup

The following information provides guidance on a way to configure your Sensipar codes that will work with the current TIME capabilities as well as the upcoming changes we’ll be making to better support managing Sensipar charges on the clinical side of TIME.

Service Codes – Sensipar Prescriptions

You will setup one set of codes for all the different dosages of Sensipar that are prescribed to your patients. This is typically going to be 30mg, 60mg, 90mg, 120mg, and 180mg. Use your standard code naming conventions for your home meds (service codes for home meds typically have start with the same letter – often an “H”). For each of these codes, make sure you set the HCPC to J0604 and make sure you set the admin dose on the service to the appropriate value. By doing this, when we update TIME with our enhancements to better support managing Sensipar prescriptions, we’ll be able to more automatically handle the generation of charges for Sensipar.

Below is a representative list of Service Codes for Sensipar Prescriptions

Code / Desc / HCPC / Admin Dose
HSE03 / SENSIPAR 30 MG (HOME MED) / J0604 / 30
HSE06 / SENSIPAR 60 MG (HOME MED) / J0604 / 60
HSE09 / SENSIPAR 90 MG (HOME MED) / J0604 / 90
HSE12 / SENSIPAR 120 MG (HOME MED) / J0604 / 120
HSE18 / SENSIPAR 180 MG (HOME MED) / J0604 / 180

As you likely already have a single Sensipar home med service code, a reasonable mechanism would be to use the Copy capability of the Service Code screen to copy it, update the Code, Description, HCPC, and Admin Dose on the copied entry to be your 30MG version of the code, then copy the 30MG entry for the remaining dosages. When done, then logically delete the original Sensipar home med service code so that new prescriptions cannot be made with it.

Service Codes – Dispensed Sensipar

As Sensipar will now need to be on dialysis claims for Medicare patients, you will need to setup a set of codes for the dispensed Sensipar. These codes will be similar to your other medication service codes that are used to generate charges in your system – one for each dosage that can be charted. In addition to the normal setup of chartable service codes, the Sensipar dispensed codes need some specific values in order for TIME to handle them for the TDAPA changes

  • HCPC – set to J0604
  • Admin Dose – set to the appropriate value
  • Units – set to M
  • Bill Dose – if billing from TIME, make sure you set the appropriate bill dose for the service
  • ASP – if billing from TIME, make sure you set the appropriate ASP value for the medication as that is used in the calculations for the TDAPA amount
  • NOTE: ASP will be the same value for all of the Dispensed Sensipar codes

Below is a representative list of Service Codes for the Dispensed Sensipar

Code / Desc / HCPC / Admin Dose / Units / Bill Dose / ASP
DSE03 / SENSIPAR 30 MG (DISPENESED) / J0604 / 30 / M / 30 / 0.909
DSE06 / SENSIPAR 60 MG (DISPENESED) / J0604 / 60 / M / 60 / 0.909
DSE06 / SENSIPAR 90 MG (DISPENESED) / J0604 / 90 / M / 90 / 0.909
DSE12 / SENSIPAR 120 MG (DISPENESED) / J0604 / 120 / M / 120 / 0.909
DSE18 / SENSIPAR 1800 MG (DISPENESED) / J0604 / 180 / M / 180 / 0.909

NOTE: We are basing the Bill Dose and ASP information from the Drugs and Biologicals Eligible for TDAPA hyperlink referenced in the “ESRD PPS Transitional Drug Add-on Payment Adjustment” hyperlink referenced in the Overview section of this document