Oncology & Hematology Coding Alert

Answer: The Federal Drug Administration (FDA) approved Neupogen or filgrastim (G-CSF), J1440 (injection, filgrastim [G-CSF], 300 mcg; [use for Neupogen]) and J1441 (injection, filgrastim [G-CSF], 480 mcg; [use for Neupogen]), for these uses:

to decrease the incidence of neutropenia in patients with non-myeloid malignancies, who are undergoing myeloablative chemotherapy, followed by marrow;
prevention of infection, as manifested by febrile neutropenia in patients treated with cytotoxic chemotherapy, from which a high incidence of associated febrile neutropenia can be anticipated in a given patient;
for use in severe symptomatic chronic neutropenia; and
for use in mobilization of peripheral stem cells when the transplant procedure is a covered benefit.

The ICD-9 codes that support the medical necessity of Neupogen include:
V42.9 organ or tissue replaced by transplant; unspecified organ or tissue (should be billed when G-CSF is given to stem cell recipients);
V58.1 (encounter for other and unspecified procedures and aftercare; chemotherapy);
V59.8 donors; other specified organ or tissue) (should be billed when G-CSF is used in priming for autologous peripheral stem cell);
V66.2 convalescence and palliative care; following chemotherapy;
V66.5 convalescence and palliative care; following other treatment (should be billed when the patient has AZT or Ganciclovir neutropenia);
205.0 myeloid leukemia; acute;
205.1 myelocytic leukemia; chronic;
238.7 other lymphatic and hematopoietic tissues; myelodysplastic syndrome; and
288.0 diseases of white blood cells; neutropenia: drug induced (chemotherapy induced, associated with bone marrow transplant).