Use This Train of Thought for Coding Monoclonal Antibody Drug Administration
Question: Our team is discussing how to validate the administration code (chemo or non-chemo) for intravenous (IV) infusions of complex biological/monoclonal antibody drugs. What administration code would you use for Benlysta? AAPC Forum Participant Answer: Benlysta is a drug most commonly used in the treatment of systemic lupus and lupus nephritis. You can find it in the HCPCS Appendix A: Table of Drugs and Biologicals, where you are directed to HCPCS code J0490 (Injection, belimumab, 10 mg). This tells you the generic name for Benlysta is belimumab. To determine the drug’s classification, you can then go to the Benlysta website, which tells you that the drug is not chemotherapy. Or, you can examine the drug’s generic name, as the suffix “-mab” is an acronym for monoclonal antibody. For IV administration purposes, CPT® classifies monoclonal antibodies as highly complex drugs or biologic agents; as such, you’ll choose the appropriate administration code from 96401-96549 (Chemotherapy administration …) depending on the type and length of the infusion. You’ll also use Z79.620 (Long term (current) use of immunosuppressive biologic), as the drug is classified as a monoclonal antibody, an inclusion term for Z79.620. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
