Oncology & Hematology Coding Alert

Question: What is the proper coding for this encounter? A patient presented for chemotherapy to treat seminoma:

10 minute IV of bleomycin (30 units)

60 minute infusion of etoposide (207 mg)

60 minute infusion of cisplatin (41.4 mg).

New Jersey Subscriber

Answer: Because the patient presented for chemotherapy, your first-listed diagnosis should be V58.11 (Encounter for antineoplastic chemotherapy). Then you should report the neoplasm being treated. Seminoma is testicular cancer. The appropriate testicular neoplasm code is 186.9 (Malignant neoplasm of other and unspecified testis). Note that ICD-9-CM includes only 186.0 (Malignant neoplasm of undescended testis) and 186.9 in the 186.x range. ICD-10-CM expands your options with the C62.- range, which includes codes specific to right, left, undescended, and descended.

Tip: The patient may have had surgery to remove the cancer (removal of one or both testes is called orchiectomy). But because the patient is still having treatment directed at that site, you should use 186.9 rather than a "history of" code. ICD-9-CM guidelines state that one of the indicators for transitioning to a "history of" code is that "there is no further treatment directed to that site" (guidelines are online at www.cdc.gov/nchs/data/icd9/icd9cm_guidelines_2011.pdf). If documentation shows the treatment is directed at metastases, then you should report the appropriate secondary neoplasm code(s).

Administration: Next, you should choose separate codes for the administration and supply of the bleomycin, etoposide, and cisplatin. When choosing an "initial" code for chemotherapy, 60-minute infusions trump a 10-minute push. So start with 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) to represent one 60-minute infusion.

Add +96417 (... each additional sequential infusion [different substance/drug], up to 1 hour [List separately in addition to code for primary procedure]) to represent the administration of a different drug by another 60-minute infusion.

To report the push, use +96411 (Chemotherapy administration; intravenous, push technique, each additional substance/drug [List separately in addition to code for primary procedure]).

Supply: Your claim also should include codes for the supply of the drugs. Be sure to include appropriate units, as well:

• Bleomycin: 2 units of J9040 (Injection, bleomycin sulfate, 15 units)
• Etoposide: 21 units of J9181 (Injection, etoposide, 10 mg)
• Cisplatin: 5 units of J9060 (Injection, cisplatin, powder or solution, 10 mg).