Oncology & Hematology Coding Alert

Question: When the oncologist uses Zevalin as monoclonal antibody therapy, should I report 79403 or a chemotherapy infusion code?

Mississippi Subscriber

Answer: The proper code to report Zevalin monoclonal antibody therapy is 79403 (Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion).

Although CPT guidelines state that chemotherapy administration codes 96401-96549 apply to monoclonal antibody agents, Zevalin is a radiopharmaceutical, making 79403 the more appropriate code.

If you bear the cost of the drug, you should also report A9543 (Yttrium Y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries).

Do the research: Many payers have strict guidelines regarding Zevalin and won't cover it as a -first line- therapy.

Trap: Don't confuse radiopharmaceutical therapy with radiopharmaceutical localization. Payers typically instruct you to report 78804 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; whole body, requiring two or more days imaging) when the provider localizes a tumor or distributes Zevalin throughout the whole body over two days or more.

You should report the Zevalin used for localization with A9542 (Indium In-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries).

Smart idea: Get each of your payers- Zevalin rules in writing because rules vary among payers.