Oncology & Hematology Coding Alert

Question: What codes should I report if we infuse a patient with refractory anemia using decitabine for just under an hour? We-re in an office setting.

Vermont Subscriber

Answer: You should use chemotherapy administration code 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug).

Decitabine is a chemotherapy drug, so you should use V58.11 (Encounter for antineoplastic chemotherapy) as your first-listed diagnosis if the infusion was the patient's main reason for presenting at your office.

You should also report 238.72 (Low-grade myelodysplastic syndrome lesions). The ICD-9 manual lists refractory anemia (RA), as well as RA with ringed sideroblasts (RARS), refractory cytopenia with multilineage dysplasia (RCMD), and refractory cytopenia with multilineage dysplasia and ringed sideroblasts (RCMD-RS), under 238.72.

For high-grade lesions, ICD-9 also includes 238.73 (High-grade myelodysplastic syndrome lesions). The manual lists RA with excess blasts-1 (RAEB-1) and RA with excess blasts-2 (RAEB-2) under 238.73.

If you bear the cost of the drug, you should also report J0894 (Injection, decitabine, 1 mg). You should report one unit per milligram used.