Oncology & Hematology Coding Alert

Question: Which infusion code category should I use for Herceptin?

Iowa Subscriber

Answer: For non-antineoplastics, checking your payer's policy on which administration codes to use is the safest route.

In a National Coverage Provision, Iowa's Part B MAC, Wisconsin Physician Services, indicates that chemotherapy administration codes apply to monoclonal antibodies, and it typically considers Herceptin  (trastuzumab) to fall into this category ("Chemotherapy and Drug Administration," HONC-002, www.wpsic.com/medicare/part_b/policy/honc002.pdf).

So you would look to codes such as 96413 and +96415 (Chemotherapy administration, intravenous infusion technique ...) to report Herceptin administration.

Remember: The appropriate HCPCS code for Herceptin is J9355 (Injection, trastuzumab, 10 mg).

-- 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.