Oncology & Hematology Coding Alert

Why you may need to report deleted codes

Has your payer denied your Zevalin therapy claims when you report codes 78804 and 79403? If so, you may need to report G0273-G0274 until your carrier updates its coding policies.

In 2004, Medicare deleted G0273 (Radiopharma-ceutical biodistribution, single or multiple scans on one or more days, pretreatment planning for radiopharma-ceutical therapy of non-Hodgkin's lymphoma, includes administration of radiopharmaceutical [e.g., radiolabeled antibodies]) and G0274 (Radiopharma-ceutical therapy, non-Hodkin's lymphoma, includes administration of radiopharmaceutical [e.g.,radiolabeled antibodies]). But some payers have not updated their Zevalin policies, and require these codes instead of 78804 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; whole body, requiring two or more days imaging) and 79403 (Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion).

Example: Noridian Administrative Services, North Dakota's Medicare carrier, stated that providers should use codes 78800-78804 for diagnostic tests involving drugs Arcitumomab, ProstaScint, Verluma and OncoScint. You can use 78800 and 78803 for scans involving MyoScint. But for Zevalin, Noridian states physicians should bill G0273. Most carriers, however, will pay for 78804 and 79403 when you report them for Zevalin treatments, as long as your documentation supports the charge.