Oncology & Hematology Coding Alert

Question: We need to report the administration of Herceptin by our physician. Please guide regarding the required documentation and units to be reported.

Florida Subscriber

Answer: You can submit your Herceptin claims with code J9355 (Injection, trastuzumab, 10 mg). When submitting these claims, remember to keep documentation supporting the weight (kg) of the patient and the dose that your physician prescribed. These are the core documents you will need to support your Herceptin claims.

Watch the units of Herceptin reported. Herceptin is available in multi-use vials. If you read the package insert, you can confirm that once reconstituted, Herceptin is stable for 28 days. You can claim a reimbursement for only the amount prescribed and administered to the patient. Do not submit the full amount of vial on claim if the entire amount has not been used.