Oncology & Hematology Coding Alert

Question: How should I report a 60-minute infusion of 508.92 mg of Vectibix for a patient with a primary neoplasm of the right colon?

Florida Subscriber

Answer: For a 60-minute infusion of Vectibix, you should report the administration using 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug).

The appropriate HCPCS supply code for Vectibix is J9303 (Injection, panitumumab, 10 mg). To calculate the units, divide the 508.92 mg administered by the 10 mg in the code definition to get 50.892. Round up to 51 for your final unit count. Medicare confirms that you may round up the number of units in Medicare Claims Processing Manual, Chapter 17, Section 70 (www.cms.gov/manuals/downloads/clm104c17.pdf).

For the primary malignant neoplasm of the right colon, you should report 153.6 (Malignant neoplasm of ascending colon). The ICD-10-CM equivalent is C18.2 (Malignant neoplasm of ascending colon).

Tip: For Vectibix administration, payer policy may restrict coverage to those patients who have had testing showing the wild type K-ras gene. Your practice should file the test results in the medical record as proof the test was completed and be prepared to present them to the payer upon request.