Oncology & Hematology Coding Alert

Question:

Wisconsin Subscriber

The most likely problem is the pairing of J9303 (Injection, panitumumab, 10 mg) with non-chemotherapy additional sequential infusion code +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion, up to 1 hour [List separately in addition to code for primary procedure]).

Here's why: Code J9303 represents panitumumab (sold as Vectibix), a monoclonal antibody. Unless your payer tells you otherwise in writing, you should report panitumumab administration using the chemotherapy administration codes. So assuming you intended the codes to report a panitumumab infusion lasting between 91 and 150 minutes, the correct administration codes would be initial hour code 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and the code representing an additional hour of chemo administration, +96415 (... each additional hour [List separately in addition to code for primary procedure]).

Code +96367 would have been appropriate if you instead wanted to report infusion of a non-chemotherapy therapeutic, prophylactic, or diagnostic substance, such as an anti-emetic or steroid, in addition to the code for an initial hour of chemotherapy infusion. If that was the case, be sure to add the appropriate HCPCS code for the non-chemotherapy substance to your claim, too.

Watch for: Many payers reimburse J9303 only for colorectal cancer patients (153.x, Malignant neoplasm of colon, or 154.x, Malignant neoplasm of rectum, rectosigmoid junction, and anus). In addition, you may need to submit a pathology report documenting the patient's KRAS gene type because certain mutations predict a lack of response to this form of therapy.