Answer: Approved by the U.S. Food and Drug Administration (FDA) late last year, Zevalin is a monoclonal antibody that works as radio-immunotherapy treatment that is both diagnostic and therapeutic. To receive reimbursement for this code, you must have a diagnosis of low-grade follicular or transformed B-cell non-Hodgkin's lymphoma (NHL). In addition, the patient receiving Zevalin must not have responded to conventional chemotherapy or Rituxan.
You can report Zevalin with several applicable codes. You have new HCPCS codes A9522 (Supply of radiopharmaceutical diagnostic imaging agent, Indium-111 ibritumomab tiuxetan, per mci) and A9523 (Supply of radiopharmaceutical therapeutic imaging agent, Yttrium 90 ibritumomab tiuxetan, per mci). You also have new G codes for the radiopharmaceutical therapy, G0273 (Radiopharmaceutical biodistribution, single or multiple scans on one or more days, pre-treatment planning for radiopharmaceutical therapy of non-Hodgkin's lymphoma, includes administration of radiopharma-ceutical [e.g., radiolabeled antibodies]) and G0274 (Radiopharmaceutical therapy, non-Hodgkin's lymphoma, includes administration of radiopharmaceutical [e.g., radiolabeled antibodies]).
Because delivery of this regimen depends on a coordinated team of oncologists, radiation oncologists, nuclear medicine physicians and others, when you report Zevalin you must account for a number of factors. For example, usually the oncologist reports the Rituxan (J9310) administered before Zevalin, sends the patient to the nuclear or radiation oncology facility for an imaging dose of Zevalin, and the physicians there report the Zevalin codes. Different coding scenarios apply when the patient receives therapeutic doses after the initial treatment day. Read more about Zevalin before reporting it: Refer to "NHL Radio-Immunotherapy Requires Teamwork" in the October 2002 Oncology Coding Alert.
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