Radiology Coding Alert

Reader Questions:

Stick to 79403 for Zevalin Therapy

Question: When I looked up Zevalin, I found out it's a monoclonal antibody. Does that mean I should report a chemotherapy administration code for Zevalin therapy? CPT guidelines say chemotherapy codes are correct for monoclonal antibodies. Louisiana Subscriber Answer: Zevalin is a monoclonal antibody, and CPT does say chemotherapy administration codes are correct for "certain monoclonal antibodies." But you should not report these codes for Zevalin therapy. What to do: You should report 79403 (Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion) because Zevalin is a radiopharmaceutical. "Code 79403 is specific for  radioimmunotherapy with radioactive materials attached to monoclonal antibodies," states AMA's CPT Assistant (September 2005). If you bear the cost of the drug, you also should report A9543 (Yttrium Y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries). Note that A9543 is specific to therapeutic use. For diagnostic use, A9542 (Indium In-111 ibritumomab tiuxetan, diagnostic, per study [...]
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