Oncology & Hematology Coding Alert

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How to Code Weekly Injection of Darbepoetin Alfa

Published on Tue Jun 19, 2018

Question: A patient who is on chemotherapy treatment for lymphoma, presents for a weekly injection of darbepoetin alfa. The patient was documented to receive 500 mcg of Aranesp subcutaneously. How can we report this service?

New Jersey Subscriber

Answer: From the description provided, it is evident that the patient reports for darbepoetin alfa injection. Darbepoetin alfa (Aranesp^®) is an erythrocyte stimulating agent and not chemotherapy. So, for this subcutaneous injection, submit HCPCS code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).

If the patient receives darbepoetin alfa for chemotherapy induced anemia, submit HCPCS level II code J0881 (Injection, darbepoetin alfa, 1 microgram [non-ESRD use]). Report one unit of code J0881 for each mcg of darbepoetin alfa administered. Therefore, 500 units of J0881 is reported.

Darbepoetin alfa: Darbepoetin alfa is a form of a protein that works to produce red blood cells in the body. Providers use darbepoetin alfa to treat anemia.

Diagnosis code: If the diagnosis is identified in the note by the physician as anemia due to chemotherapy and the encounter was for treatment of anemia, ICD-10-CM code D64.81 (Anemia due to antineoplastic chemotherapy) and is the first listed. In this scenario, the patient developed anemia secondary to chemotherapy used in the treatment of lymphoma. If administered for a different reason, the coding of the diagnosis and even the drug may be different. Verify the physician’s order and/or visit note supports all coding reported.

There is no site specified in the question to differentiate the lymphoma and underlying malignancy in the patient. For unspecified site of lymphoma, you submit ICD-10-CM code C85.10 (Unspecified B-cell lymphoma, unspecified site). If a more specific type of lymphoma is supported, check the ICD-10-CM series C82.50 (Diffuse follicle center lymphoma, unspecified site) to C86.4 (Blastic NK-cell lymphoma) for a more definitive code.