Oncology & Hematology Coding Alert

Question: Are Sandostatin Depot injections considered nonhormonal chemo injections (96401) or therapeutic injections (90772) if given for a diagnosis of carcinoid tumor?

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Answer: The correct code for a Sandostatin injection is 90772 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). Even though oncologists sometimes use the drug to treat neoplasms, Sandostatin (octreotide acetate) is not actually an antineoplastic agent, so the chemotherapy codes would not be appropriate.

Note that in 2009, CPT will delete 90772 and replace it with a new code, 96372, which will have the same descriptor.

ICD-9 tip: Check with your payers for their coverage limits and acceptable diagnoses. According to Novartis, the maker of Sandostatin, ICD-9 codes that may show medical necessity for the drug include:

- 157.4 -- Malignant neoplasm of pancreas; islets of Langerhans

- 211.7 -- Benign neoplasm of other parts of digestive system; islets of Langerhans

- 253.0 -- Acromegaly and gigantism

- 259.2 -- Carcinoid syndrome.

Don't miss: For the supply of the drug, report J2353 (Injection, octreotide, depot form for intramuscular injection, 1 mg) for Sandostatin LAR. If you instead use the immediate-release form, report J2354 (Injection, octreotide, nondepot form for subcutaneous or intravenous injection, 25 mcg).