Oncology & Hematology Coding Alert

Question: What are the proper codes for this encounter? The diagnosis is malignant pleural mesothelioma.

• 10:04-10:14 p.m., Alimta, 960 mg
• 10:45 a.m.-12:45 p.m., CDDP, 144 mg

New Mexico Subscriber

Answer: This case includes a 10-minute push of Alimta (pemetrexed) and a two-hour infusion of CDDP (cisplatin).

CDDP: You should choose the "initial substance" code based on the longer administration time required for the cisplatin. The appropriate coding for a two-hour infusion of the same substance is:

• 1 unit of 96413, Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
• 1 unit of +96415, ... each additional hour (List separately in addition to code for primary procedure).

You should report 15 units of J9060 (Injection, cisplatin, powder or solution, 10 mg) for the 144 mg administered (144 mg divided my 10 mg equals 14.4, round up to 15).

Alimta: The 10-minute administration of pemetrexed qualifies for push code +96411 (Chemotherapy administration; intravenous, push technique, each additional substance/drug [List separately in addition to code for primary procedure]). According to CPT®, one of the definitions of push is "an infusion of 15 minutes or less," which makes the push code most appropriate for this admin service. This definition reveals one reason why it's important to remind your staff to document stop times for each injection or infusion given.

To report the supply of pemetrexed, you should assign 96 units of J9305 (Injection, pemetrexed, 10 mg) (960 mg divided by 10 mg equals 96 units).

Diagnosis: For a chemotherapy encounter, the appropriate first-listed code is V58.11 (Encounter for antineoplastic chemotherapy). You also should report the malignancy being treated. Based on the information provided, the most appropriate code is 163.9 (Malignant neoplasm of pleura unspecified).

Note that ICD-10-CM, scheduled to become effective Oct. 1, 2014, offers a mesothelioma-specific code: C45.0 (Mesothelioma of pleura).