Oncology & Hematology Coding Alert

Oncology and radiology teams can now offer people with low-grade, follicular or transformed B-cell non-Hodgkin's lymphoma (NHL) a much improved quality of life with ibritumomab tiuxetan (Zevalin) - the first radio-immunotherapy treatment approved by the FDA for the treatment of NHL. Zevalin represents a new kind of cancer killer - a monoclonal antibody with an extra kick of radiation attached that boosts its tumor-killing power. The new radioimmunotherapy uses the body's own defenses (the immune system) to fight cancer. Coders should understand that the new treatment is "part diagnostic and part therapeutic," says Sandy Smith, a coding specialist at Tristan Associates in Harrisburg, Pa.

Smith's clinic has discovered that evolving coding strategies will likely require the same close attention to detail that the treatment does. She says Zevalin has "only been approved in February of this year, and we did our first patient at the end of July."

Zevalin "is probably the first in a series," says Elaine Towle, CMPE, practice administrator for New Hampshire Oncology and Hematology in Hooksett. "I think we'll see more treatment options once this therapy gets established." The First Days of the Cycle - Imaging Dose Monoclonal antibody therapy with Zevalin is administered by intravenous infusion, generally over the course of about a week on an outpatient basis. Delivery of the regimen depends on a coordinated team of oncologists, nuclear medicine physicians or radiation oncologists, nurses, pharmacists and technicians. However, Towle says, the treatment will require a lot of clear communication between the players to make sure the patient's care is handled correctly.

Coders need to understand that "coordination of care is absolutely critical" at all levels, stresses Paul DeLioa, CEO of Tristan Associates in Harrisburg, Pa., which is a Zevalin-ready clinic. "We have an oncology group in the same building as us, so we've worked in close partnership to develop guidelines for delivery of this therapy."

Although the mechanics of administering the Zevalin will happen in another department, the oncologist is still ultimately responsible for the care of the patient, Towle says. "Additionally, if there are problems, symptoms or side effects, those are still our issue." Here's how it works. On the first day, the patient received an intravenous infusion of 250 mg/m2 rituximab (Rituxan, J9310), which takes several hours. The appropriate chemotherapy administration codes for this procedure are 96410 and 96412. The rituximab will allow for improved targeting of the cancer cells.

Following this infusion, the patient travels to a nuclear or radiation oncology facility to receive an imaging dose of indium-111 Zevalin (J9999 or A4661) over the course of about 10 minutes. The oncology coder will submit only for the Rituxan, while the hospital department, whether it is radiology or another department, will be billing [...]