Radiation oncology coders may soon be sorting out codes for ibritumomab tiuxetan therapy (Zevalin) a newly approved radioimmunotherapy treatment for patients with low-grade, follicular or transformed B-cell non-Hodgkin's lymphoma (NHL).
To submit clean claims, coders will want to distinguish between pretreatment imaging and therapeutic codes because Zevalin administration is a two-step process that is "part diagnostic and part therapeutic," says Sandy Smith, a coding specialist at Tristan Associates in Harrisburg, Pa.
Zevalin coding can get very tricky because delivery of the regimen requires lots of providers. "Coordination of care is absolutely critical," stresses Paul DeLioa, CEO of Tristan Associates, which is a Zevalin-ready clinic. As part of the coordinated team, radiology coders will have to know which codes they need to get right for each phase of the therapy. Radiology coders will primarily be charged with assigning correct codes for imaging, which occurs during the first phase of the process, and for reporting the Zevalin doses. The First Days of the Cycle - Imaging Dose Zevalin represents a new kind of cancer-killer - a monoclonal antibody with an extra kick of radiation attached that boosts its tumor-killing power. Monoclonal antibody therapy with Zevalin is administered by intravenous infusion, generally over the course of about a week on an outpatient basis.
Here's how it works. On the first day, the patient receives an intravenous infusion of 250 mg/m2 rituximab (Rituxan, J9310), which targets the cancer cells. Following this infusion, the patient travels to a nuclear or radiation oncology facility to receive an imaging dose of indium-111 Zevalin (A4641). Between two and 24 hours after the infusion of indium-111 Zevalin, the radiologist takes whole body images with a gamma camera. Additional images may be taken again 48 to 72 hours later. The treatment team uses these images to chart the path of the radio-tagged drug in the body and to assess how well it is targeting tumor cells. For each biodistribution scan performed, Medicare accepts one of the following codes:
78800 - Radiopharmaceutical localization of tumor; limited area 78801 - ... multiple areas
78802 -... whole body. "Our clinic did the whole body imaging with 78802," Smith says.
"We did that twice, once when the patient first came in for the indium-111 and then when they came in for the second dose of yttrium-90," DeLioa says.
The
Radiology Coder should report the scanning and the radiopharmaceutical drug, while the oncology department will be billing for the Rituxan, Smith says. Payment for infusion is packaged into the imaging scans and should not be billed separately. Medicare is differentiating between hospitals and diagnostic centers, DeLioa says, "so as a free-standing diagnostic center, we are using A4641 (Diagnostic radiopharmaceutical), the drug name, and the NDC [...]
