Oncology & Hematology Coding Alert

Question: The following administration encounter is for a patient with high risk monoclonal IgG kappa multiple myeloma, relapse confirmed with bone marrow biopsy. Which codes apply to this case?

8A-10A, IV Aredia, 30 mg

10:05A-10:06A, push IV Aloxi, 0.25 mg

10:10A-10:25A, push IV dexamethasone, 20 mg

10:45A-11:40A, IV Cytoxan, 500 mg

Colorado Subscriber

Answer: The appropriate diagnosis code for this patient’s condition is 203.02 (Multiple myeloma, in relapse). The ICD-10-CM equivalent is C90.02 (Multiple myeloma in relapse).

Remember: If the patient presented primarily for chemotherapy, your first-listed diagnosis code should be V58.11 (Encounter for antineoplastic chemotherapy). Under ICD-10-CM, the appropriate code is Z51.11 (Encounter for antineoplastic chemotherapy).

Although the Cytoxan was the last drug administered, you should report an initial code for its administration because it is the only chemotherapy drug in this encounter. For the administration, you should report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the 55-minute infusion. For the 500 mg supply, you should report 5 units of J9070 (Cyclophosphamide, 100 mg).

Aredia is used to treat and prevent bone complications (prevent fracture, treat bone pain, etc.). Choose +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion of a new drug/substance, up to 1 hour [List separately in addition to code for primary procedure]) for the first hour. For the second hour, add +96366 (… each additional hour [List separately in addition to code for primary procedure]). For the supply, you’ll need only 1 unit of J2430 (Injection, pamidronate disodium, per 30 mg).

Aloxi helps to prevent nausea and vomiting. The administration time appears to be one minute or less, so you should use push code +96375 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug [List separately in addition to code for primary procedure]). To report the supply, use J2469 (Injection, palonosetron HCL, 25 mcg). To determine the units, you have to compare the dose (0.25 mg) to the code’s per unit definition (25 mcg). The 0.25 mg dose equates to 250 mcg. So you need 10 units to report the dose administered (250 mcg administered divided by 25 mcg in the code definition).

Finally, for the dexamethasone 15-minute push, you should report an additional unit of +96375. Claim 20 units of J1100 (Injection, dexamethasone sodium phosphate, 1 mg) for the supply of this glucocorticoid steroid.