Oncology & Hematology Coding Alert

Question: I am working with a provider who prescribed Avastin as part of a patient’s cancer treatment process. My questions is, since Avastin isn’t really a chemo drug, how do I go about coding this? I can’t find any other code that would fit this medication.

Rhode Island Subscriber

Answer: When a patient comes in for Avastin only, you can use the code 96413 (Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug).

This code, along with 96415 (Chemotherapy administration, intravenous infusion technique; each additional hour [List separately in addition to code for primary procedure]) and 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]), are used for “other highly complex drug or highly complex biologic agents” in addition to chemotherapeutic drugs. Avastin is a monoclonal antibody and is identified with HCPCS code J9035 (Injection, bevacizumab, 10 mg) in the chemotherapeutic section of the HCPCS manual.

In this case, Avastin would be considered a highly complex substance even though it is not specific to chemo. This is why the proper code for you to use in your case is from the 964XX code category for the specific infusion administered.