Oncology & Hematology Coding Alert

Question: Which codes apply to the following infusion encounter? The patient has renal cancer with metastasis to the vena cava.

·         9AM-9:20AM: Diphenhydramine 25 mg IV in 50 mL NS

·         9:25AM-9:55AM: Temsirolimus 25 mg IV in 250 mL NS

Wisconsin Subscriber

Answer: This patient has an infusion of diphenhydramine (antihistamine) followed by an infusion of temsirolimus (anticancer kinase inhibitor).

Initial: Although the temsirolimus was administered second, you should choose an “initial” administration code for the anticancer agent. The reason is that CPT^® guidelines state, “For physician or other qualified health care professional reporting, an initial infusion is the key or primary reason for the encounter reported irrespective of the temporal order in which the infusion(s) or injection(s) are administered.”

The appropriate initial code is 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug).

The appropriate HCPCS code for the supply of temsirolimus is J9330 (Injection, temsirolimus, 1 mg). Report 25 units for the 25 mg administered because the code definition indicates you should report 1 unit per 1 mg.

Subsequent: Next, report the diphenhydramine administration using a subsequent administration code: +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion of a new drug/substance, up to 1 hour [List separately in addition to code for primary procedure]).

To report the supply of diphenhydramine, choose J1200 (Injection, diphenhydramine HCl, up to 50 mg). Report a single unit because the 25 mg administered falls within the definition’s per unit amount of up to 50 mg.

Finally, report the renal cancer using 189.0 (Malignant neoplasm of kidney except pelvis). You also should report the metastasis to the vena cava using 198.89 (Secondary malignant neoplasm of other specified sites).

Tip: ICD-10-CM is scheduled to replace ICD-9-CM on Oct. 1, 2014. ICD-10-CM divides the codes for primary kidney neoplasms into right, left, and unspecified options:

·         C64.1, Malignant neoplasm of right kidney, except renal pelvis

·         C64.2, Malignant neoplasm of left kidney, except renal pelvis

·         C64.9, Malignant neoplasm of unspecified kidney, except renal pelvis.

For metastasis to the vena cava, the appropriate ICD-10-CM code is C79.89 (Secondary malignant neoplasm of other specified sites).