Oncology & Hematology Coding Alert

Untangle your ICD-10 coding options by specifying location and laterality.

Are you puzzled when it comes to the interleukins and antibodies related to malignant melanomas? Then you’re not alone.

Check out these chemotherapy coding tips, and examine the C codes you should apply on your malignant melanoma claim.

Learn with This Interleukin Example

First of all, you should look at a common scenario. If a patient has malignant melanomas, your oncologist may use interleukins. Before you lose focus, try to figure out a definitive code for this therapy.  

Example: If your physician administers aldesleukin, turn to code J9015 (Injection, aldesleukin, per single use vial).

What is aldesleukin? Aldesleukin (Proleukin®) is a recombinant form of interleukin-2 produced by using the recombinant DNA technology using a strain of Escherichia coli bacterium.

Bill for every vial: Aldesleukin is available in a single-use vial. One whole vial of aldesleukin contains 22 million international units. You have no other choice but to bill for the whole vial, even if only part of it was used, says Leah Fuller, CPC, Consultant, Pinnacle Enterprise Risk Consulting Services, LLC, CO.

Wastage: Document the dosage delivered, the total amount contained in the single-use vial, and the amount of drug that was wasted.

Example: Suppose your physician administered 4 million units three times a week to a patient with melanoma. In this case, you should bill the entire vial three times a week.

Administration code: Aldesleukin is administered by a 15-minute intravenous infusion every 8 hours. You should submit code 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug) or +96411 (Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure)) for the IV push of aldesleukin.

List Other Common Agents

Here are some examples of other biological/chemotherapy options your physician may use for malignant melanoma:

• J9214 (Injection, interferon, alfa-2b, recombinant, 1 million units)
• J9228 (Injection, ipilimumab, 1 mg).

Check the Recent Advances in Chemotherapy

Are you proficient at coding J9271 (Injection, pembrolizumab, 1 mg) for pembrolizumab (Keytruda®)? Find out.

What is pembrolizumab?  Pembrolizumab is a programmed death receptor-1 (PD-1)-blocking monoclonal antibody indicated for the treatment of patients with unresectable or metastatic melanoma. It prevents the growth and spread of cancer cells.

Available strengths and dosage:

• 50 mg lyophilized powder in single-use vial for reconstitution
• 100 mg/4 mL (25 mg/mL) solution in a single-use vial.

Dosage: According the package insert, the dosage for Melanoma is 200mg every 3 weeks. Pembrolizumab is administered as an intravenous infusion over 30 minutes every 3 weeks.

The Center for Medicare and Medicaid Services (CMS) introduced this permanent J-Code for Keytruda® effective January 1, 2016. Submit one unit of code J9271 for every 1 mg of pembrolizumab injected.

Administration code: The injection of pembrolizumab is typically administered over 30 minutes, hence you submit code 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for this service.

Not All Options Have a Code

With advances in the management of malignant melanoma, a number of biologicals are increasingly being used.

Example: Common biologicals used in malignant melanoma include trametinib, cobemetinib, and vemurafenib. These agents do not have a dedicated J code. Submit code C9399 (Unclassified drugs or biologicals).

Note: For drugs and biologicals without a specific HCPCS code, you can use an unclassified oncology drug code. Refer to the box on page 43.

Diagnosis Coding for Malignant Melanoma

When reporting chemotherapy, be vigilant with your diagnosis coding. Let location be your guide to the right ICD-10-CM code for malignant melanoma. Look at the C43 (Malignant melanoma of skin) series for the right code depending upon where the melanoma is located. For example, if your physician documents malignant melanoma of the lip, you submit code C43.0 (Malignant melanoma of lip) and for the nose, you submit code C43.31 (Malignant melanoma of nose).  

Similarly, you will find discrete codes for eyelids and external auricular canals, both right and left. Additionally, options exist for both upper and lower eyelid. For the diagnosis of malignant melanoma of eyelids and canthi, choose from the following:

• C43.10 (Malignant melanoma of unspecified eyelid, including canthus)
• C43.111 (Malignant melanoma of right upper eyelid, including canthus)
• C43.112 (Malignant melanoma of right lower eyelid, including canthus)
• C43.121 (Malignant melanoma of left upper eyelid, including canthus)
• C43.122 (Malignant melanoma of left lower eyelid, including canthus).

For malignant melanoma of the external auricular canals, look at the following codes:

• C43.20 (Malignant melanoma of unspecified ear and external auricular canal)
• C43.21 (Malignant melanoma of right ear and external auricular canal)
• C43.22 (Malignant melanoma of left ear and external auricular canal).

Other codes for face, scalp, and neck: When your physician does not specify where on the face the tumor was located, turn to code C43.30 (Malignant melanoma of unspecified part of face). When your physician specifies any other part of the face (for example, cheek), you submit code C43.39 (Malignant melanoma of other parts of face). For scalp and neck, you look at code C43.4 (Malignant melanoma of scalp and neck).

Melanoma on trunk and limbs: For malignant melanoma of the trunk and upper and lower limb, you choose from the following:

• C43.51 (Malignant melanoma of anal skin)
• C43.52 (Malignant melanoma of skin of breast)
• C43.59 (Malignant melanoma of other part of trunk)
• C43.60 (Malignant melanoma of upper limb, including shoulder)
• C43.61 (Malignant melanoma of right upper limb, including shoulder)
• C43.62 (Malignant melanoma of left upper limb, including shoulder)
• C43.70 (Malignant melanoma of unspecified lower limb, including hip)
• C43.71 (Malignant melanoma of right lower limb, including hip)
• C43.72 (Malignant melanoma of left lower limb, including hip).

Not sure of location? The tumor may involve more than one location. In this case, you have code C43.8 (Malignant melanoma of overlapping sites of skin). When your physician does not specify any location, submit code C43.9 (Malignant melanoma of skin, unspecified).

Utilize These Unclassified Oncology Drug Codes

You may encounter situations where you need to apply an unclassified drug code. Such examples are:

J9999 (Not otherwise classified, antineoplastic drugs)
J8999 (Prescription drug, oral, chemotherapeutic, NOS)
J3490 (Unclassified drugs)
J3591 (Unclassified drug or biological used for ESRD on dialysis)
Q0181 (Unspecified oral dosage form, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for a IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen)
J8499 (Prescription drug, oral, non chemotherapeutic, NOS)
J7599 (Immunosuppressive drug, not otherwise classified)
C9399 (Unclassified drugs or biologicals).

Note: When billing an unclassified medication using a CMS 1500 claim form, you must include both the HCPCS code (e.g., J8999) in the item 24D and the drug name, strength, and National Drug Code (NDC) in item 19 or 24A (shaded area) in order to ensure appropriate reimbursement. However, check with your payers for any specific requirements when filing claims.