Oncology & Hematology Coding Alert

Question: Is thrombotic thrombocytopenic purpura a covered diagnosis for Rituximab infusions?

Idaho Subscriber

Answer: The answer depends on individual payers. CIGNA, the current Part B carrier for Idaho, does cover Rituximab infusions for thrombotic thrombocytopenic purpura (TTP) patients under certain conditions: "For those patients with persistent inhibitors and who have failed to achieve control with conventional plasma exchange and steroid therapy."

The TTP patient must also "be CD20 positive" for coverage. Rituximab is "directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes," explains CIGNA's local coverage determination L12204.

Coding: The appropriate diagnosis code for TTP is 446.6 (Thrombotic microangiopathy). You should use chemotherapy administration codes for the infusion (such as 96413, Chemotherapy administration, intravenous infusion technique ...).

If you bear the cost of the Rituximab, report J9310 (Injection, rituximab, 100 mg).

Tip: Search Medicare coverage at www.cms.hhs.gov/mcd/search.asp.

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and past president of the AAPC National Advisory Board.