Oncology & Hematology Coding Alert

Prepare for October 1 by checking out this ICD-9 and ICD-10 equivalent table.

By standardizing your claims for bortezomib for Medicare, Medicaid, and private health plans, you can establish order and consistency in your reporting. Defy a denial or delay in payment for bortezomib administration in the physician office setting by following some simple guide rules.

When you read that your physician administers bortezomib, you can earn all you deserve if you can appropriately code for:

1. Drug
2. Drug administration services
3. Diagnosis

Let’s consider each of these three steps in detail.

Code for the Drug

When you report bortezomib, you submit HCPCS code J9041 (Injection, bortezomib, 0.1 mg), you will need to calculate and report the correct number of units of J9041 depending upon the amount of drug that your physician administered. 

Example: You may read that your physician administered 2.26 mg of Velcade. In this case, you will report 23 units of J9041. Each 0.1 mg of bortezomib is reported as one unit of J9041. 

Check Route of Administration

When working on claims for bortezomib, the second step for you is to identify how the drug was administered and supported in the documentation. Your physician may administer the drug through the subcutaneous or intravenous route. The appropriate code for subcutaneous administration is 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic). Your physician may also document an administration by push. If so, you would change over to code 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug). “You may also report code 96411 (Chemotherapy administration; intravenous, push technique, each additional substance/drug [List separately in addition to code for primary procedure]) if it is used in a 3-drug combination or other combined therapy where another anti-neoplastic substance is provided and is reported with the “initial” administration code for that encounter,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Director of reimbursement and advisory services, Altegra Health, Inc. 

Never Miss the Diagnosis Codes

Your physician will prescribe bortezomib for the treatment of patients with multiple myeloma. Another common indication is for the treatment of patients with mantle cell lymphoma who have received at least one prior therapy.

When reporting multiple myeloma, you can select from the following diagnosis codes depending upon whether the patient is in remission or relapse:

• 203.00, Multiple myeloma, without mention of having achieved remission
• 203.01, Multiple myeloma in remission
• 203.02, Multiple myeloma, in relapse

These ICD-9-CM codes map to ICD-10-CM codes, C90.00 (Multiple myeloma not having achieved remission), C90.01 (Multiple myeloma in remission), and C90.02 (Multiple myeloma in relapse), respectively. 

Table 1 lists the ICD-9-CM and the corresponding ICD-10-CM codes for mantle cell lymphoma. You pick up the right code by using the fifth digit designation, based on the location of the lymphoma and nodal involvement.

Lastly, you needn’t bother to confirm specifications for different payers. Coding for bortezomib is uniform and is accepted by Medicare, Medicaid, and other private payers