Oncology & Hematology Coding Alert

Question: Our physician prescribed olaratumab for a patient diagnosed with soft tissue sarcoma. Is this an approved therapy for this condition? How can we report for this therapy?

New York Subscriber

Answer: Olaratumab is approved for the treatment of soft tissue sarcoma. On October 19, 2016, the FDA granted an accelerated approval to olaratumab for the treatment of adults with certain types of soft-tissue sarcoma. You can read the details of this approval at: http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm525878.htm.

HCPCS coding: There is no dedicated HCPCS code for olaratumab. You code for this agent as unclassified. You can submit code J9999 (Not otherwise classified, antineoplastic drugs).

Diagnosis code: For malignant neoplasm of the soft tissues, you identify a code form the C49 (Malignant neoplasm of other connective and soft tissue) series depending upon the anatomical location of the tumor. If your physician does not specify the location of the soft tissue sarcoma, you can submit the ICD-10-CM code C49.9 (Malignant neoplasm of connective and soft tissue, unspecified).

Administration code: Olaratumab is typically administered as infusion over an hour. You submit code 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the administration.