Oncology & Hematology Coding Alert

Question: How do we code for Adcetris administration?

Virginia Subscriber

Answer: According to Palmetto GBA, J11 Part B MAC for Virginia, you should submit the following:

• CPT®: 96413, Chemotherapy administration, intravenous infusion technique; up to one hour
• HCPCS: J9999, Not otherwise classified antineoplastic drugs
• ICD-9: 200.60-200.68 (Anaplastic large cell lymphoma) or 201.00-201.98 (Hodgkin's disease), depending on documentation.

Enter a single unit for the HCPCS code. A 30 minute IV infusion is the typical administration method, which would equal a single unit of 96413.

You'll also need to include specific information in the comment field for Palmetto:

• NDC number
• Adcetris
• Dose given.

Finally, be sure to send a copy of the invoice. The MAC states, "Until Palmetto GBA receives enough claims to determine a price, providers must submit an invoice copy for this drug."

To find the directions for J11 providers, head to www.palmettogba.com/palmetto/providers.nsf/DocsCatHome/Jurisdiction%2011%20Part%20B and enter "Adcetris" in the Search field. This will bring up a link to "Adcetris (brentuximab vedotin) Injection: FDA Approval."

Background: The Palmetto site notes that the FDA approved Adcetris for:

• "Hodgkin lymphoma after failure of autologous stem cell transplant (ASCT) or after failure of at least two prior multi-agent chemotherapy regimens in patients who are not ASCT candidates"
• "Systemic anaplastic large cell lymphoma after failure of at least one prior multi-agent chemotherapy regimen."