Oncology & Hematology Coding Alert

Question: The patient presented for a 2.21 mg subcutaneous Velcade injection, 20 mg of IV Dex (sodium phosphate) over 15 minutes, and then 4 mg IV Zometa over 15 minutes. The patient's multiple myeloma has relapsed. Which codes should we report?

Colorado Subscriber

Answer: There are many factors to consider in reporting this case, including administration methods and infusion times.

Velcade: For the administration of Velcade, an anti-cancer drug, be sure to note the administration method: subcutaneous injection. The appropriate code for this administration is 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic).

Physicians also may order Velcade administration by push, which would change the coding to 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug).

For the 2.21 mg supply of Velcade, you should report 23 units of J9041 (Injection, bortezomib, 0.1 mg).

Dex: To report the dexamethasone (corticosteroid) 15-minute infusion, you should report push code 96374 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; intravenous push, single or initial substance/drug). You may report an initial code in this case because the chemotherapy was administered by subcutaneous injection rather than by IV access. Therefore the 96374 reflects the work involved in initializing the IV access.

Code J1100 (Injection, dexamethasone sodium phosphate, 1mg) is appropriate for the dex supply. You should report 20 units.

Zometa: Like the dexamethasone, staff administered the Zometa as a push. Because this is a sequential push of a new drug, you should report +96375 (... each additional sequential intravenous push of a new substance/drug [List separately in addition to code for primary procedure]).

For the supply of Zometa, a drug used to reduce bone complications, you should report 4 units of J3487 (Injection, zoledronic acid [Zometa], 1 mg).

Diagnosis: Your first-listed diagnosis code should be V58.11 (Encounter for antineoplastic chemotherapy). Then report the multiple myeloma using 203.02 (Multiple myeloma, in relapse).