Oncology & Hematology Coding Alert

Question: We're a freestanding facility. How should I report a 61-minute infusion of decitabine for a patient with refractory anemia?

California Subscriber

Answer: Decitabine is an antineoplastic drug, so unless your payer tells you otherwise in writing, you should report 96413 (Chemotherapy administration,intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the 61-minute infusion. Some payers may maintain that decitabine does not merit a chemotherapy administration drug and may ask for a code such as 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) instead. (The OIG noted this confusing reality in a 2009 report available at http://oig.hhs.gov/oei/reports/oei-09-08-00190.pdf.)

HCPCS: Don't forget to report the drug (sold under the name Dacogen) using J0894 (Injection, decitabine, 1 mg). The entity bearing the cost of the drug should be the one to report it.

ICD-9: For the diagnosis coding, depending on payer guidelines, report V58.11 (Encounter for antineoplastic chemotherapy) as your first-listed diagnosis (assuming the infusion was the reason for the visit). You should then code the refractory anemia (RA) to 238.72 (Low grade myelodysplastic syndrome lesions). ICD-9 includes a number of diagnoses under this code:

• RA with excess blasts-1 (RAEB-1)
• RA with ringed sideroblasts (RARS)
• refractory cytopenia with multilineage dysplasia (RCMD)
• refractory cytopenia with multilineage dysplasia and ringed sideroblasts (RCMD-RS).

Note that ICD-9 used to include RAEB-1 under 238.73 (High grade myelodysplastic syndrome lesions) alongside RAEB-2, but now the manual lists only RAEB-2 under 238.73.