Oncology & Hematology Coding Alert

Question: A patient with a history of breast cancer presents for treatment of newly diagnosed metastatic disease in her lungs (overlapping sites). She receives 56 mg Taxotere (one hour infusion) and 188 mg Herceptin (32 minutes). How should we report this case?

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Answer: Because the patient is presenting for chemotherapy, you should report V58.11 (Encounter for antineoplastic chemotherapy) as the first-listed diagnosis code. Then, because the treatment is aimed at the metastatic lung disease, you should report 197.0 (Secondary malignant neoplasm of lung). Finally, because the patient has a "history of breast cancer," you should report V10.3 (Personal history of malignant neoplasm of breast).

For the one-hour Taxotere administration, you should report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug). Report the Taxotere using J9171 (Injection, docetaxel, 1 mg). Report 56 units for the 56 mg administered.

You should use a "sequential" infusion code for the administration of the second drug: +96417 (Chemotherapy administration, intravenous infusion technique; each additional sequential infusion [different substance/drug], up to 1 hour [List separately in addition to code for primary procedure]). Code the Herceptin using J9355 (Injection, trastuzumab, 10 mg). Report 19 units to reflect the 188 mg administered. (Divide 188 mg by the 10 mg in the definition to get 18.8. Round up to get 19 units.)