Oncology & Hematology Coding Alert

Code J9999 is your drug code of choice until a more specific option is available.

Attention Palmetto GBA providers: If your physician orders Kyprolis for multiple myeloma patients, be sure your claims match these recently released guidelines.

Background: In July 2012, the FDA approved Kyprolis (carfilzomib) for the treatment of multiple myeloma. It's considered a third line treatment because the "patient must first have received two prior therapies including bortezomib and an immunomodulatory agent, and must have shown disease progression within 60 days of completion of the last treatment regimen," Palmetto states.

Administration: Typically, physicians order the drug to be administered as a push over two to 10 minutes. A sample schedule could include admin on days 1, 2, 8, 9, 15, and 16, followed by a 12-day rest period from days 17 to 28. One treatment cycle is 28 days.

Documentation: Palmetto instructs its providers that the medical record must confirm the patient received 4 mg of the steroid dexamethasone either orally or by IV before each Kyprolis dose. This rule applies during the first cycle and again during the first cycle of dose escalation (usually cycle 2).

Coding: Physicians reporting the drug supply to Palmetto should use J9999 (Not otherwise classified, antineoplastic drugs) and include the treatment line number, the drug name, and the amount administered. Claims must include ICD-9-CM code 203.02 (Multiple myeloma, in relapse).

Palmetto doesn't include administration coding instructions in the guidelines, but you should choose the appropriate IV infusion code, such as 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug).

Resource: Palmetto posted the guidelines for both J1 and J11 Part B providers. Start at www.palmettogba.com/medicare. In the left-hand menu, choose the link for either the J1 or J11 Part B MAC. On the resulting page, choose Browse by Topic and then Drugs & Biologicals. In the list at the bottom of the new page, click "Kyprolis (Carfilzomib) Coding and Billing Guidelines and Indications" to access the posting.